Neonatal conjunctivitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 5, 2016
StartDiseasesNeonatal conjunctivitis

Neonatal conjunctivitis, which is also referred to as ophthalmia neonatorum, is an eye condition that affects babies shortly after birth. It can affect somewhere between 1 percent and 12 percent of all infants. The condition causes symptoms affecting the eyes and generally requires medical treatment. 

Contents

Definition & Facts

Neonatal conjunctivitis is a form of conjunctivitis that occurs within the first four weeks postnatal. Babies may develop neonatal conjunctivitis in one or both eyes hours, days, or weeks after birth. The primary causes of this early form of conjunctivitis are bacterial infection, inflammation caused by chemicals, or viral infections.

The infection or irritant in the eye causes discharge or drainage, which is commonly accompanied by pus. When infectious causes are diagnosed, medical treatment is necessary. If left untreated, neonatal conjunctivitis can cause serious, permanent damage to the eye, including blindness

Symptoms & Complaints

The most common symptom associated with neonatal conjunctivitis is discharge from the eye. Although the type of discharge and its consistency may differ depending on the underlying cause of the condition, some discharge is present in all types of conjunctivitis.

The majority of symptoms and associated complaints occur within hours to days of birth, but some symptoms may not manifest for up to two weeks postnatal. Generally, once symptoms present they remain constant and tend to increase in severity if left untreated. In some cases, particularly with certain causes, the symptoms may be intermittent or come and go. Common symptoms include:

In severe cases, it is also possible for other related symptoms to occur. Infectious conjunctivitis can spread to surrounding systems and may affect the ears, sinuses, nose, and lungs. Other related symptoms may include: 

Causes

The causes of neonatal conjunctivitis are either aseptic/non-infectious or septic/infectious. In aseptic cases, the conjunctivitis is generally caused by factors occurring immediately after birth or within the first few weeks of life. Causes of aseptic neonatal conjunctivitis include:

  • Reaction to silver nitrate solution
  • Reaction to administered eye drops or ointments
  • Blocked tear duct

The most common cause of aseptic conjunctivitis in newborns is the use of silver nitrate solution, which is commonly administered immediately after birth to prevent conjunctivitis. In the case that the preventative treatments for conjunctivitis are the cause, symptoms usually appear immediately after birth.

Causes of septic neonatal conjunctivitis are:  

Septic neonatal conjunctivitis is most commonly passed from the mother to the child in the birth canal. This is commonly caused by sexually transmitted infection of the mother with the most common cause being chlamydia. It is also possible that other bacteria or viruses present in the mother can be transmitted to the child during birth and can affect the eyes. In some cases, conjunctivitis can occur when bacteria or viruses are transmitted to the eye after birth by parents or caregivers. It may take a couple of days to up to two weeks for symptoms to present.

Diagnosis & Tests

Diagnosis and testing for neonatal conjunctivitis is often carried out by pediatric physicians in conjunction with an ophthalmologist or eye specialist. The mother may also require testing to aid in diagnosis, and this will generally be carried out by the obstetrician or gynecologist.

The diagnostic process will begin with an eye examination to look for symptoms and clinical signs of conjunctivitis. If discharge or drainage is present, a culture or swab will be obtained for laboratory testing. Medical staff may also conduct certain eye exams like slit lamp examinations to look for signs of damage to the surface and structures of the eye.

A blood sample may also be collected for laboratory testing. Tests of the eye cultures and blood work will look for signs of infection and attempt to determine the underlying cause of the infant’s condition. Conjunctivitis caused by a bacterial or viral infection can easily be identified by laboratory testing. A vaginal culture from the mother may also aid in diagnosing the specific agent causing the infection.

If no bacterial or viral causes are found, additional tests may be necessary, including the use of diagnostic imaging techniques to search for internal causes. In benign cases like those caused by a blocked tear duct, the diagnosis is generally determined during the physical examination.

Treatment & Therapy

The treatment for neonatal conjunctivitis will vary depending on the underlying cause of the eye infection. In aseptic cases caused by a reaction to eye drops or ointments the treatment is generally required and symptoms will improve on their own within a couple of days. Other aseptic causes like blocked ducts may also resolve without treatment. Blocked ducts can often be treated without medical intervention by applying warm compresses or providing gentle massage to the area. 

Septic causes of conjunctivitis likely require medical treatment and can result in serious harm, including permanent blindness if left untreated. Commonly lavage or flushing of the affected eye will be completed on a routine basis until discharge is no longer present. Antibiotic treatments may be applied to the eye using drops or ointment. This treatment will continue on a routine basis for a specified number of days until the bacteria is destroyed. Other antibiotic treatments provided by injection may be necessary as well. Intravenous (IV) fluids may be called for.

Prevention & Prophylaxis

The most effective prevention of neonatal conjunctivitis occurs before birth. If possible, proper measures should be taken during pregnancy to treat any genital infections. This will prevent the spread of disease to the child during birth.

As a preventative measure, antibiotic eye drops or ointment is applied to the infant’s eyes shortly after birth to prevent infection. Proper hygiene, including frequent hand washing by parents and caregivers can also help prevent infection and reduce the spread of conjunctivitis. These preventative measures have greatly reduced the occurrence of neonatal conjunctivitis.