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| neonatal_conjunctivitis [2026/02/16 20:50] – created Scott Larson | neonatal_conjunctivitis [2026/02/16 21:27] (current) – [Treatment] Scott Larson | ||
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| =====Signs/ | =====Signs/ | ||
| + | * Gonococcal conjunctivitis- hyperacute onset (first 3 days up to 3 weeks of life) with copious, purulent conjunctival discharge | ||
| + | * marked eyelid edema | ||
| + | * chemosis | ||
| + | * Corneal involvement in 33% with corneal ulceration and possible perforation | ||
| + | * Chlamydial conjunctivitis- subacute onset (5 days to several weeks postpartum) with follicles on everted lower eyelid | ||
| + | * blood-stained discharge in 33% | ||
| + | * eyelid edema | ||
| + | * concurrent lung, nasopharynx, | ||
| + | * genital tract involvement is often present but may be asymptomatic | ||
| ===== Causes ===== | ===== Causes ===== | ||
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| * Adenovirus 1.8% | * Adenovirus 1.8% | ||
| * Bocavirus 0.6% | * Bocavirus 0.6% | ||
| - | * Herpes simplex | + | * Herpes simplex, rare |
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| * Suspect chlamydial ophthalmia | * Suspect chlamydial ophthalmia | ||
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| * Gram stain of conjunctival exudate looking for gram-negative intracellular diplococci | * Gram stain of conjunctival exudate looking for gram-negative intracellular diplococci | ||
| * Culture | * Culture | ||
| - | * Dual testing | + | * Dual testing |
| + | =====Treatment===== | ||
| + | * Chlamydial ophthalmia neonatorum | ||
| + | * erythromycin base or ethyl succinate 50 mg/kg/day divided QID x 14 days | ||
| + | * in infants <6 weeks, watch for infantile hypertropic pyloric stenosis as a side effect | ||
| + | * Gonococcal ophthalmia neonatorum | ||
| + | * ceftriaxone 25-50 mg/kg IV or IM x 1 dose (not to exceed 250 mg) | ||
| + | * consider substitute in neonates with hyuperbilirubinemia | ||
| + | * do not give if receiving IV calcium | ||
| + | * substitute: cefotaxime 100 mg/kg IV or IM x 1 dose | ||
| + | * Coinfection with the above two is common so combined treatment should be considered | ||
| + | * Other bacteria: consider moxifloxicin TID or QID x 10 days guided by culture with close follow-up | ||
| + | * Viral- consider [[acyclovir|antiviral treatment]] for suspected HSV infection. | ||