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Ophthalmia Neonatorum

Ophthalmia neonatorum is also referred to as neonatal conjunctivitis and is associated with an acute, mucopurulent inflammation of ocular tissues of neonates. It typically affects newborns within their first month of life.


Presentation

In cases of infectious ON, incubation periods vary with the causative agent. Neonates may acquire Chlamydia trachomatis or Neisseria gonorrhoeae from their infected mothers during birth, and symptom onset typically occurs 5 to 14 days or 2 to 5 days afterwards, respectively [1]. Other infectious diseases may be contracted later on and may thus manifest in newborns aged two weeks and older. Initially, catarrhal conjunctivitis may be observed. Ocular discharge may turn mucopurulent within a few days, and additional signs like chemosis, eyelid edema, blepharitis, and keratitis may be noted. In severe cases, corneal ulcers may form and lead to blindness. The presence of respiratory symptoms may indicate the concomitant involvement of respiratory system. Affected neonates commonly present feeding difficulties.

ON due to the instillation of silver nitrate generally manifests within two days.

Weakness
  • RESULTS: Each of the eight included studies had substantial methodologic weaknesses. Data to estimate the efficacy of prophylaxis in the prevention of gonococcal ophthalmia neonatorum (GON) were not available.[ncbi.nlm.nih.gov]
  • Rhinoscleroma, Klebsiella pneumonia Klebsiella granulomatis Granuloma inguinale Klebsiella oxytoca Escherichia coli : Enterotoxigenic Enteroinvasive Enterohemorrhagic O157:H7 O104:H4 Hemolytic-uremic syndrome Enterobacter aerogenes / Enterobacter cloacae Slow/weak[en.wikipedia.org]
Lymphadenopathy
  • […] gonorrhea. 1 Viral conjunctivitis Viral conjunctivitis is most commonly caused by adenovirus and herpes simplex virus. 1, 6 Infants with adenovirus ON might present with petechial hemorrhage or occasionally with large subconjunctival hemorrhages. 1 Lymphadenopathy[ncbi.nlm.nih.gov]
  • The viral form is caused by herpes simplex virus and adenovirus, with lymphadenopathy associated with 50% of the cases. 3 There is also chemical pink eye (conjunctivitis) associated with the use of silver nitrate and, secondarily, erythromycin and tetracycline[scielo.br]
Feeding Difficulties
  • Affected neonates commonly present feeding difficulties. ON due to the instillation of silver nitrate generally manifests within two days. As it has been indicated above, distinct pathogens may account for infectious ON.[symptoma.com]
Anemia
  • […] period. [3] Poor perinatal outcomes such as respiratory failure, compromised immunity due to premature birth, neonatal sepsis from an ascending maternal infection, premature rupture of membranes, placental abruption, postpartum sepsis, and maternal anemia[meajo.org]
Respiratory Distress
  • Control neonates had either neonatal jaundice or mild respiratory distress but no signs of conjunctivitis. 2 controls matched for age and sex were chosen for each neonate with conjunctivitis.[ncbi.nlm.nih.gov]
  • Other neonatal risk factors (51%) included sepsis, jaundice, and respiratory distress [Table 3].[meajo.org]
Jaundice
  • Control neonates had either neonatal jaundice or mild respiratory distress but no signs of conjunctivitis. 2 controls matched for age and sex were chosen for each neonate with conjunctivitis.[ncbi.nlm.nih.gov]
  • Uncommonly, systemic infection can cause jaundice, hepatosplenomegaly, pneumonitis, meningoencephalitis and disseminated intravascular coagulation.[patient.info]
  • Other neonatal risk factors (51%) included sepsis, jaundice, and respiratory distress [Table 3].[meajo.org]
Red Eye
  • The neonates were in an apparently healthy state, but showed red eyes with abundant greenish-yellow secretion, mild chemosis and lid edema.[ncbi.nlm.nih.gov]
  • Diagnostic Considerations Exclude other potential causes of acute red eye, such as preseptal cellulitis or orbital cellulitis. Congenital dacryostenosis is another condition to consider in the differential diagnosis of neonatal conjunctivitis.[emedicine.medscape.com]
  • Results: Of the neonates receiving the one eye drop application, 18.4% returned with a red eye with discharge, 4.0% had organisms found on the initial smear, and 8.2% had a positive culture.[bjo.bmj.com]
  • Depending on the pathogen, there may be a mixed picture of a red eye with lid swelling and a varying amount of purulent discharge.[patient.info]
Eye Irritation
  • Applying medication to the eyes of newborns may result in mild eye irritation and has been perceived by some parents as interfering with mother-infant bonding.[cps.ca]
Blepharospasm
  • Characterized by lacrimation, blepharospasm, keratitis and corneal opacity. ophthalmia neonatorum a purulent conjunctivitis occurring during the first 10 days of life, before the eyelids separate in puppies and kittens.[medical-dictionary.thefreedictionary.com]

Workup

As it has been indicated above, distinct pathogens may account for infectious ON. It is of major importance to identify the causative pathogen in individual cases. Infections with Chlamydia trachomatis or Neisseria gonorrhoeae may cause systemic disease and life-threatening complications like pneumonia and sepsis. Although less frequently reported, complications may also arise from infections with other pathogens [7]. It is important to note that the determination of the etiological agent and its susceptibility to antimicrobials is of significant therapeutic relevance [8].

In order to prove the presence of bacterial pathogens, conjunctival swabs should be taken and samples should be prepared for Gram staining [9], bacterial culture, and molecular biological assays. Of note, Chlamydia trachomatis is an obligate intracellular microorganism and thus can not be grown on conventional media [10]. It is best detected by means of polymerase chain reaction. In contrast, Neisseria gonorrhoeae may be grown on Thayer-Martin or Martin-Lewis agar. Nevertheless, nucleic acid amplification tests may also be carried out to detect this pathogen and are increasingly replacing conventional methods.

Molecular biological assays are also indicated to prove the presence of viral pathogens.

Neisseria Gonorrhoeae
  • Infections with Chlamydia trachomatis or Neisseria gonorrhoeae may cause systemic disease and life-threatening complications like pneumonia and sepsis.[symptoma.com]
  • Chlamydia trachomatis and Neisseria gonorrhoea were responsible for less than 5% of all cases.[ncbi.nlm.nih.gov]
Candida
  • Most infants acquire the herpes simplex infection during the birth process. [13] Fungi such as Candida albican have been reported to cause conjunctivitis in the neonatal period. [6] The conjunctivitis is usually part of an Endophthalmitis resulting from[sudanmedicalmonitor.org]

Prognosis

  • Ophthalmia Neonatorum Prognosis Neonatal conjunctivitis reacts to apt treatment and the prognosis is considered to be really good.[hxbenefit.com]
  • Prognosis Chlamydial infection : - 80% fully recover after one course of treatment. Further treatment courses may be required [ 11 ].[patient.info]
  • Outlook (Prognosis) Quick diagnosis and treatment often leads to good outcomes.[mountsinai.org]

Etiology

ON may indicate an infection with either of the following bacterial pathogens [6]:

Rarely, ON results from an infection with adenoviruses or herpes simplex virus [5].

Silver nitrate has been used to prevent neonatal conjunctivitis induced by Neisseria gonorrhoeae. However, this measure may provoke non-infectious, chemical conjunctivitis.

Epidemiology

  • There was no evidence of a major role for perinatally transmitted C trachomatis infection in trachoma epidemiology.[ncbi.nlm.nih.gov]
  • Recently, this organism has exhibited a change in its epidemiology and has been identified as a cause of severe neonatal infections.[uncch.pure.elsevier.com]
  • Whether distinct epidemiologic forces among human populations or biologic characteristics of the organism are responsible for the different routes of transmission is uncertain.[journals.lww.com]
Sex distribution
Age distribution

Pathophysiology

  • Abstract The microbiology, epidemiology and pathophysiology of ophthalmia neonatorum are reviewed with special emphasis on its prevention and management in the developing world.[ncbi.nlm.nih.gov]
  • Pathophysiology Vertical transmission from the mother is the route of transmission to the affected newborn. Both parents, however, should be screened for STD infection [ 7, 12 ].[omicsonline.org]
  • […] birth PROM [5] Ocular trauma during delivery Mechanical ventilation Prematurity Poor prenatal care Poor hygienic delivery conditions Post-delivery infection due to direct contact with health care workers or by aerosolization Silver nitrate exposure Pathophysiology[eyewiki.aao.org]

Prevention

  • Abstract The microbiology, epidemiology and pathophysiology of ophthalmia neonatorum are reviewed with special emphasis on its prevention and management in the developing world.[ncbi.nlm.nih.gov]

Summary

Ophthalmia neonatorum (ON), a condition also referred to as neonatal conjunctivitis, is defined as an inflammation of the mucous membranes of the eye of newborns during their first month of life. ON may be a result of bacterial or viral infection, or may be caused by the instillation of chemical agents. While many cases resolve spontaneously within a few days, severe complications may occur [1]. In fact, ON may result in blindness [2] [3]. Fortunately, ON-associated morbidity has decreased significantly since antimicrobial medications have become widely available.

Newborns may contract the respective infections during vaginal delivery or postnatally from colonized family members or healthcare professionals; chemical ON is related to the prophylaxis of infectious ON. Nevertheless, prophylactic measures are indicated in neonates born to mothers suffering from chlamydia infection or gonorrhea, and in all newborns in underdeveloped regions with high prevalence rates of these sexually transmissible diseases. No consensus has been reached regarding the application of prophylactic measures in neonates born to apparently healthy mothers in developed countries [4] [5].

References

Article

  1. Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G. Neonatal conjunctivitis - a review. Malays Fam Physician. 2008;3(2):77-81.
  2. Andalibi S, Haidara M, Bor N, Levin M. An Update on Neonatal and Pediatric Conjunctivitis. Curr Ophthalmol Rep. 2015;3:158.
  3. Adachi K, Klausner JD, Xu J, et al. Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected Pregnant Women and Adverse Infant Outcomes. Pediatr Infect Dis J. 2016;35(8):894-900.
  4. Schaller UC, Klauss V. Is Crede's prophylaxis for ophthalmia neonatorum still valid? Bull World Health Organ. 2001;79(3):262-263.
  5. Matejcek A, Goldman RD. Treatment and prevention of ophthalmia neonatorum. Can Fam Physician. 2013;59(11):1187-1190.
  6. Borer A, Livshiz-Riven I, Golan A, et al. Hospital-acquired conjunctivitis in a neonatal intensive care unit: Bacterial etiology and susceptibility patterns. Am J Infect Control. 2010;38(8):650-652.
  7. Kumar JB, Silverstein E, Wallace DK. Klebsiella pneumonia: An unusual cause of ophthalmia neonatorum in a healthy newborn. J AAPOS. 2015;19(6):564-566.
  8. Fruchtman Y, Greenberg D, Shany E, Melamed R, Peled N, Lifshitz M. Ophthalmia neonatorum caused by multidrug-resistant Neisseria gonorrhoeae. Isr Med Assoc J. 2004;6(3):180-181.
  9. Alexandre I, Cortes N, Justel M, Fernandez I, Ortiz de Lejarazu R, Pastor JC. The value of simple microbiological studies for on-site screening of acute neonatal conjunctivitis in Angola. J Ophthalmic Inflamm Infect. 2014;4(1):1.
  10. Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014;63(RR-02):1-19.

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Last updated: 2019-07-11 20:57