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.

• Laboratory Technician

  The laboratory technicians had no knowledge of which prophylactic ocular medication dose was given to any infant. [bjo.bmj.com]

• 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]

• 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]

• Conjunctival Injection

  Serratia marcescens Pseudomonas sp., rarely occur but may cause corneal perforation, blindness & death Time of onset: 2-5 days postpartum Clinical presentation: Eyelid edema Conjunctival injection w/ discharge Chemosis Milder course w/o corneal & systemic [specialty.mims.com]

  Signs/Symptoms Non-specific signs of neonatal conjunctivitis include conjunctival injection, tearing, mucopurulent or non-purulent discharge, chemosis, and eyelid swelling. [eyewiki.aao.org]

  Specific common types of bacterial infection are: Gonorrhoeal infection - typically, 2-5 days after birth but it may occur later: hyperacute conjunctival injection and chemosis, lid oedema and severe purulent discharge. [patient.info]

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.

Bacterial conjunctivitis rarely fails to respond to treatment. [emedicine.medscape.com]

In both cases, erythromycin was the most common first line of treatment. Two hundred and twenty-two (78.72 %) ophthalmologists replied that prophylactic treatment is required in their country. [springermedizin.de]

Ophthalmia Neonatorum Prognosis Neonatal conjunctivitis reacts to apt treatment and the prognosis is considered to be really good. [hxbenefit.com]

The format includes the CPT codes for billing purposes, short description of the condition, etiology/incidence, course/prognosis, laboratory findings, differential diagnosis; prophylaxis, treatment (local and systemic, surgical or other), miscellaneous [books.google.ro]

Prognosis Chlamydial infection : - 80% fully recover after one course of treatment. Further treatment courses may be required [ 11 ]. [patient.info]

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

• Chlamydia trachomatis
• Neisseria gonorrhoeae
• Staphylococcus aureus
• Staphylococcus epidermidis
• Streptococcus pneumoniae
• Streptococcus viridans
• Enterobacter spp.
• Escherichia coli
• Klebsiella pneumoniae
• Proteus spp.
• Serratia marcescens
• Haemophilus influenzae
• Pseudomonas aeruginosa

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.

There was no evidence of a major role for perinatally transmitted C trachomatis infection in trachoma epidemiology. [ncbi.nlm.nih.gov]

Infection Control & Hospital Epidemiology ISSN: 0899-823X EISSN: 1559-6834 URL: /core/journals/infection-control-and-hospital-epidemiology Unfortunately you do not have access to this content, please use the Get access link below for information on how [journals.cambridge.org]

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]

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]

[…] 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]

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]

Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary care clinical settings, including screening tests, counseling, and preventive medications. [aafp.org]

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]

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].

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.