Neonatal Conjunctivitis

Signs/Symptoms

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 infection >50%
- genital tract involvement is often present but may be asymptomatic

Bacteria (36%)
- Staphylococcus aureus 16%
- Moxarella catarrhalis 9%
- Streptococcus pneumoniae 3%
- Pseudomonus aeruginosa- rare
- Nisseria gonorrhoeae (0.4 per 100,000)
Chlamydia trachomatis (<40%)
Viral (5%)
- Rhinovirus 2.4%
- Adenovirus 1.8%
- Bocavirus 0.6%
- Herpes simplex, rare

Suspect chlamydial ophthalmia
- obtain specimin from everted eyelid using Dacron-tipped swab or other specific swab
- specimin must contain conjunctival cells
- Direct fluorescent antibody (DFA) is the only FDA-cleared non-culture test.
- Nucleic acid amplification test (PCR) may be used by CLIA approved labs
- Culture
Suspect gonococcal ophthalmia
- Gram stain of conjunctival exudate looking for gram-negative intracellular diplococci
- Culture
Dual testing for both of the above is recommended

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 antiviral treatment for suspected HSV infection.