Neonatal conjunctivitis

Conjunctivitis is a potentially blinding condition with associated systemic manifestations

:sparkles::sparkles: RECOGNITION AND ASSESSMENT :zap:Conjunctival redness
:zap:Swelling of conjunctiva and eyelids
:zap:Purulent or mucopurulent discharge

:sparkles::sparkles:Differential diagnosis
:zap:Sticky eye with blocked tear duct
:zap:Congenital glaucoma

:white_check_mark:Bacterial :white_check_mark:Staphylococcus aureus :white_check_mark:Haemophilus influenzae
:white_check_mark:Streptococcus pneumoniae
:white_check_mark:Serratia spp, :white_check_mark:E. Coli, :white_check_mark:Pseudomonas spp

:point_right::point_right:Neisseria gonorrhoeae
typical onset aged 0–5 days
mild inflammation with sero-sanguineous discharge to thick, purulent discharge with tense oedema of eyelids

:point_right::point_right:Chlamydia trachomatis
typical onset aged 5–14 days
mild-to-severe swelling with purulent discharge (may be blood-stained)

:white_check_mark:Viral :white_check_mark: Herpes simplex virus (HSV)

:zap:Sticky eye/blocked tear duct
:white_check_mark:4–6 hrly eye toilet using sodium chloride 0.9%
:white_check_mark:cooled, boiled tap water acceptable for home use

:zap::zap:Swab all for: :point_right: Gram stain and bacterial culture and sensitivities
:point_right: if other suspicions of HSV (e.g. vesicles etc.), swab in viral transport media for HSV PCR

:zap::zap:Treat both eyes with:
:white_check_mark: frequent eye toilet as necessary
:white_check_mark:chloramphenicol 0.5% eye drops
:white_check_mark: fusidic acid 1% eye drops for staphylococcus

:point_right::point_right:Presentation ≤24 hr of birth suggests gonococcal infection – inform consultant paediatrician

:point_right::point_right:SUBSEQUENT MANAGEMENT
In severe non-resolving cases
*⃣Take throat and eye swabs for viral PCR *⃣If herpes suspected, look for other signs of herpetic infection
*⃣Treat suspected herpes with aciclovir IV and topical for 14 days
*⃣Refer to ophthalmology

:point_right::point_right:Neisseria gonorrhoeae suspected
:white_check_mark:Request urgent Gram stain and culture Swab in viral transport media for PCR :white_check_mark:Assess baby for septicaemia
:point_right::point_right: Neisseria gonorrhoeae confirmed
:white_check_mark:Give single dose cefotaxime 100 mg/kg IV stat
:white_check_mark:For severe cases, frequent sodium chloride 0.9% irrigation of the eyes and continue treatment with cefotaxime IV for up to 5 days
:sun_with_face: Refer to ophthalmology
:sun_with_face: If due to Neisseria gonorrhoea or chlamydia discuss referral to the genitourinary medicine services

:point_right::point_right:Chlamydia result positive
:white_check_mark::white_check_mark:Treat with erythromycin 12.5 mg/kg oral 6-hrly for 14 days

:point_right::point_right:Gonococcal or chlamydia infection detected Refer mother and partner to genitourinary medicine for immediate treatment