Ophthalmia Neonatorum

Question 1

Other name for ophthalmia neonatorum

Answer 1

Neonatal conjunctivitis

Question 2

What is ophthalmia neonatorum ?

Answer 2

Bilateral inflammation of the conjunctiva occurring in infants less than 30 days of age

ANY DISCHARGE or even WATERING from the eyes during the first week of life should arouse the suspicion of ophthalmia neonatorum as tears are not formed until then

Question 3

Mode of infection

Answer 3

Before birth

During birth

After birth

Question 4

Source of infection

Answer 4

Before birth - through infected liquor amnii in mothers with ruptured membrane

During birth - In vaginal delivery through infected birth canal especially when there’s face presentation or forceps delivery

After birth - during first bath / from clothes or fingers soiled with infected Lochia

Question 5

Causes of neonatal conjunctivitis / ophthalmia neonatorum

Answer 5

By povidine iodine or other antibiotics (silver nitrate) - chemical neonatal conjunctivitis

Gonococcal infection - still a problem in developing countries

Other bacteria - staphylococcus aureus , streptococcus pneumoniae , streptococcus hemolyticus , haemophilia species

Chlamydia serovars / serotypes - D to K - neonatal inclusion conjunctivitis - most common in developing countries

Herpes simplex 2 virus - herpes simplex ophthalmia neonatorum

Question 6

Clinical features of ophthalmia neonatorum

Answer 6

Pain and tenderness on the eyeball
Eyelids swollen
Conjunctival discharge(purulent discharge - gonococcal), hyperaemia , chemosis
Corneal involvement - herpes simplex ophthalmia neonatorum

Question 7

What are the complications of ophthalmia neonatorum?

Answer 7

Untreated cases of gonococcal ophthalmia neonatorum leads to corneal ulceration causing opacification , staphyloma formation

Question 8

Prophylactic treatment of ophthalmia neonatorum

Answer 8

Antenatal measures
Natal measures
Post natal measures

Question 9

What are the antenatal measures of prophylaxis ?

Answer 9

Through care of the mother and prompt treatment in suspected genital infections

Surveillance of women during third trimester of pregnancy for chlamydia , gonococcal , herpetic infection should be done

Question 10

Natal measures for prophylaxis

Answer 10

Deliveries carried out in hygienic conditions
Newborn ‘s closed lids should be thoroughly cleansed and dried

Question 11

Postnatal measures of prophylaxis

Answer 11

Povidine iodine - 2.5%

Tetracycline 1% or erythromycin 0.5% ointment

Single injection of ceftriaxone 50mg/kg IM or IV - should be given to infants born to mother with untreated gonococcal infections

Question 12

What is crede’s method ?

Answer 12

Here 1% of silver nitrate solution was put immediately into the eyes after birth

Question 13

Treatment for chemical and herpes simplex ophthalmia neonatorum

Answer 13

Both are self limiting but for herpes simplex topical antivirals are also added for effective treatment and to prevent recurrence ; intravenous acyclovir is given in cases of suspected systemic herpes infection

Question 14

Treatment for neonatal inclusion conjunctivitis

Answer 14

Topical tetracycline 1% or erythromycin 0.5% qid for 3 weeks

Systemic - erythromycin 50mg/kg/day 3-4 times a day for 2-3 weeks or azithromycin 20mg/kg single dose or once daily for 3 days

Question 15

Treatment for gonococcal

Answer 15

Refer book pg 74