Preventing ophthalmia neonatorum Flashcards
What is neonatal ophthalmia?
It is conjunctivitis occurring within the first four weeks of life
What are the pathogens responsible?
N Gonorrhoeae -
What is a differential for infectious conjunctivitis?
Blocked tear ducts
Chemical exposure
Which pathogen is responsible for bad disease?
N Gonorrhoeae
Other pathogens cause mild disease
What are the complications of N Gonorrhoeae?
Corneal ulceration
perforation of the globe
permanent vision loss
What are some preventative measures that have been used and what are their drawbacks
Silver nitrate - causes chemical conjunctivitis
Tetracycline and erythromycin ointments - N Gonorrhoea has resistance to these antibiotics
Gentamicin ointment - severe occur reactions
If mom has an untreated chlamydia infection, what are the risks to the baby? Would ocular treatment/prophylaxis help?
50% risk of acquiring conjunctivitis
30-50% risk of developing neonatal conjunctivitis
10-20% risk of chlamydia pneumonia
Ocular prophylaxis does not prevent transmission or progression to eye or lung disease
We used to give neonates oral erythromycin to prevent chlamydia. Why did we stop this?
It was associated with pyloric stenosis. So we no longer give prophylaxis if mom had untreated chlamydia
So if mom has an untreated chlamydia infection, what should we do with the baby?
SVD or C/S: monitor kid. If asymptomatic, nil. No routine cultures
Treat only if infection occurs
What is the best way to prevent Gonorrhea and Chlamydia infection in babies?
Screen moms and treat them at their first prenatal visit.
Positive women need to be retested after treatment and in the third trimester.
You should also treat the partners
Many provinces have laws that say that prophylaxis must be used. What should we use?
0.5% erythromycin base
Place on lower eye lid, close eyelids and massage gently to spread ointment. 1 min later, you can get rid of excess.
Does the CPS recommend prophylaxis?
No. It may no longer be useful and therefore should not be routinely recommended.
If a mom had no prenatal care, so was not screened for C or G, what should you recommend?
What if mom is unreliable?
Screen at delivery and ensure follow up if the results are not available at discharge. advise mom to watch for eye discharge in the first week of life.
If mom is unreliable, you can consider giving baby 1 x dose of ceftriaxone
What do you do if mom had untreated gonorrhoea? Does the mode of delivery matter?
Test the baby and treat immediately (before results are available).
No mode of delivery does not matter
What treatment would you give neonate who’s mom had untreated gonorrhoea?
If well appearing: conjunctival culture and ceftriaxone x 1
NB the biliary stasis of ceftriaxone is not a risk if it is just one dose
If unwell appearing: BCx, CSF and conjunctiva + ceftriaxone
