Neonatal conjunctivitis

Last updated: November 29, 2022

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Neonatal conjunctivitis is inflammation of the conjunctiva in infants < 4 weeks of age. Most cases are caused by perinatally transmitted infections (e.g., gonorrhea, chlamydia), however, rarely, neonatal conjunctivitis may result from a reaction to antimicrobial prophylaxis given at birth (aseptic neonatal conjunctivitis). Common features include conjunctival injection, swollen eyelids, and ocular discharge. Untreated infections may progress rapidly, causing blindness and systemic infection. Culture of the conjunctiva and exudate should be performed for neonates exhibiting clinical features of neonatal conjunctivitis before initiating immediate antimicrobial therapy. All patients should be monitored for signs of neonatal sepsis and specialists should be consulted early in management. Neonatal conjunctivitis is rare in high-income countries because of the implementation of comprehensive preventive measures (i.e., counseling on sexually transmitted infection prevention, antenatal screening and treatment of infections, and prophylactic antibiotics at birth).

Overview of conjunctivitis in newborns [1][2]

Neonatal gonococcal conjunctivitis [1][2][3]

Chlamydial neonatal conjunctivitis [2][3]

Neonatal HSV conjunctivitis [1]

Aseptic neonatal conjunctivitis

  • Usually due to silver nitrate exposure
Onset after birth
  • Typically 2–5 days
  • Typically 5–14 days
  • Usually up to 14 days [1]
  • Usually the first day
Clinical features
  • Flush eye with saline.

Epidemiological data refers to the US, unless otherwise specified.

Infants infected with C. trachomatis may present with pneumonia 3 weeks to 3 months after birth; this may be after conjunctivitis has resolved. [1]

Approach [1]

Neonatal conjunctivitis is an acute medical emergency that can rapidly result in blindness and/or systemic infection.

Antimicrobial therapy for neonatal conjunctivitis

Treatment is often unsuccessful (∼ 20%) in infants with chlamydial conjunctivitis; reassess after the course of antibiotics is complete, as a second course may be required. [1]

Avoid ceftriaxone in neonates who are premature, have hyperbilirubinemia, or require calcium-containing IV solutions (e.g., parenteral nutrition). [3]

Closely monitor infants aged ≤ 6 weeks for hypertrophic pyloric stenosis after oral erythromycin use. [3]

We list the most important complications. The selection is not exhaustive.

Prenatal measures [1][3][4]

Treatment of active sexually transmitted infections in mothers can prevent most cases of newborn conjunctivitis. [1]

At birth [1][5]

If maternal screening was not performed during pregnancy, test for C. trachomatis and N. gonorrhoeae during labor or delivery. [1]

  1. AAP Committee on Infectious Diseases. Red Book: 2021–2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics ; 2021 : p. 407-417
  2. Varu DM, Rhee MK, Akpek EK, et al. Conjunctivitis Preferred Practice Pattern®. Ophthalmology. 2019; 126 (1): p.P94-P169. doi: 10.1016/j.ophtha.2018.10.020 . | Open in Read by QxMD
  3. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and Reports. 2021; 70 (4): p.1-187. doi: 10.15585/mmwr.rr7004a1 . | Open in Read by QxMD
  4. Kapoor VS, Evans JR, Vedula SS. Interventions for preventing ophthalmia neonatorum. Cochrane Database Syst Rev. 2020; 2020 (9). doi: 10.1002/14651858.cd001862.pub4 . | Open in Read by QxMD
  5. Curry SJ, Krist AH, et al. Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum. JAMA. 2019; 321 (4): p.394. doi: 10.1001/jama.2018.21367 . | Open in Read by QxMD
  6. Rennie JM. Rennie & Roberton's Textbook of Neonatology E-Book. Elsevier Health Sciences ; 2012
  7. Lyons CJ, Lambert SR. Taylor and Hoyt's Pediatric Ophthalmology and Strabismus, E-Book. Elsevier Health Sciences ; 2022
  8. Isaacs D. Evidence-Based Neonatal Infections. John Wiley & Sons ; 2014
  9. Kliegman RM, MD RM, Stanton BF, et al.. Nelson Textbook of Pediatrics, 20th edition. Elsevier Health Sciences ; 2015
  10. Mannis MJ, Holland EJ. Cornea, E-Book. Elsevier Health Sciences ; 2021
  11. Yanoff M, Duker JS. Ophthalmology, Fifth edition E-Book. Mosby ; 2018
  12. Kreisel K, Weston E, Braxton J, Llata E, Torrone E. Keeping an Eye on Chlamydia and Gonorrhea Conjunctivitis in Infants in the United States, 2010–2015. Sex Transm Dis. 2017; 44 (6): p.356-358. doi: 10.1097/olq.0000000000000613 . | Open in Read by QxMD
  13. Thanathanee O, O'Brien TP. Conjunctivitis: systematic approach to diagnosis and therapy.. Curr Infect Dis Rep. 2011; 13 (2): p.141-8. doi: 10.1007/s11908-011-0167-y . | Open in Read by QxMD

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