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., , antenatal screening and treatment of infections, and prophylactic antibiotics at birth).
|Neonatal gonococcal conjunctivitis || |
Chlamydial neonatal conjunctivitis 
Neonatal HSV conjunctivitis 
Aseptic neonatal conjunctivitis
|Etiology|| || || |
|Onset after birth|| || || || |
|Clinical features|| |
|Prevention|| || |
- Prevalent in resource-limited countries: significant cause of pediatric blindness in these countries 
- Incidence in the US is approximately: 
- 30–50% of infants born to mothers with gonorrhea or chlamydia will develop neonatal conjunctivitis. 
Epidemiological data refers to the US, unless otherwise specified.
- Transmitted perinatally via exposure in utero or during vaginal delivery 
- Common pathogens include: 
- Develop within 2–28 days of birth; dependent on etiology 
- Common features include: 
- May be accompanied by systemic symptoms depending on the causative pathogen 
- All patients: Obtain Gram stain, Giemsa stain, and culture of the conjunctiva and conjunctival exudate. 
- Consider the following, depending on the suspected etiology (see also “Overview of neonatal conjunctivitis”): 
- Further studies may be necessary if there is suspicion for systemic infection, e.g.:
- Maintain a very low threshold for treatment initiation. 
- Start based on the suspected etiology.
- Urgently consult pediatric infectious diseases and/or ophthalmology.
- Initiate contact precautions: Isolate infected neonates with their mothers away from other infants. 
- Clean the patient's eyes at least every 4–6 hours with a sterile swab soaked in saline. 
- Monitor for signs of Neonatal HSV infection”). (see “ ” and “
- If necessary, treat mothers and partners for genitourinary infections, e.g., gonorrhea, chlamydia.
Antimicrobial therapy for neonatal conjunctivitis
- third-generation cephalosporin (IV or IM) :
- Pseudomonal conjunctivitis: Urgently consult infectious diseases; topical and systemic antibiotics are required. 
- Other bacterial conjunctivitis 
IV acyclovir 
- Specialists may consider adjunctive topical antivirals.
- See also “ .”
Prenatal measures 
- Offer patients and their partners .
- Provide antenatal screening for C. trachomatis and N. gonorrhea.
- Treat the mother and any partners for confirmed infections, e.g.: 
- Rescreen mothers treated for bacterial sexually transmitted infections.
At birth 
- Provide all newborns with routine ophthalmic antibiotic prophylaxis within 1 hour of birth. 
Neonates whose mothers have an untreated or undertreated infection
- N. gonorrhea: Give presumptive treatment (see “Antimicrobial therapy for neonatal conjunctivitis”). 
- C. trachomatis 
- Active maternal genital herpetic lesions