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.

• Swelling

  Those symptoms are redness and swelling of the lining of the eyelid and a watery discharge from the eyes that may include pus or blood. [sharecare.com]

  Newborn conjunctivitis; Conjunctivitis of the newborn; Ophthalmia neonatorum; Eye infection - neonatal conjunctivitis Conjunctivitis is swelling or infection of the membrane that lines the eyelids and covers the white part of the eye. [mountsinai.org]

  Twelve-day-old with five-day history of progressive lid swelling and discharge typical of chlamydial conjunctivitis. [slideshare.net]

  The eyelids also swell. [boldsky.com]

• Asymptomatic

  Although most infections in fathers were asymptomatic, the mothers were at high risk for complications. [ncbi.nlm.nih.gov]

  […] is particularly vulnerable to infection because of the lack of immunity and the absence of local lymphoid tissue at birth Predisposing factors Infection of the maternal birth canal as the result of sexually-transmitted disease This infection may be asymptomatic [college-optometrists.org]

  […] developing conjunctivitis. [1] The World Health Organization Global Incidence report in 1999 found that globally, female adolescents had the highest rate of C. trachomatis ranging from 24.1% to 27% percent, and that 70-75% of women infected worldwide were asymptomatic [meajo.org]

  […] originating in the perinatal period P35-P39 2019 ICD-10-CM Range P35-P39 Infections specific to the perinatal period Applicable To Infections acquired in utero, during birth via the umbilicus, or during the first 28 days after birth Type 2 Excludes asymptomatic [icd10data.com]

• Falling

  Indeed, Dr Vendantham’s interest in neonatal dacryocystitis would also fall within the same question since the reflux from the tear duct causing this infection generally does not arise until well after the first day of life. [bjo.bmj.com]

  In recent times there has been a change in the bacterial population of organisms causing opthalmia neonatorum, the most striking feature being the steady fall in the incidence of gonococcal opthalmia neonatorum.1 The presence of gram-negative intracellular [healio.com]

  (TE3) You have to clean not to fall onto the skin, to remain in the eye, and when you clean it is always from the corner of the eye to the inside. [scielo.br]

  ^ "Gonorrhoea treatment resistance risk falls but new diagnoses rise". Health Protection Agency. 12 September 2012. Archived from the original on 14 July 2014. ^ a b Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). [en.wikipedia.org]

• 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]

• Fatigue

  Of the invited professionals, only one professional refused to participate in research due to fatigue. Among those who accepted, there was no dropout. [scielo.br]

• Aspiration

  Neonates presented with low Apgar scores (19%), fever (8%), and/or meconium aspiration (5%). Providers treated patients empirically with a varied combination of benzyl penicillin, gentamicin, tetracycline eye ointment, and saline eye wash. [ncbi.nlm.nih.gov]

  The most common risk factors for the neonates were a low Apgar score (19%) fever (8%), and meconium aspiration (5%) [Table 3]. Other neonatal risk factors (51%) included sepsis, jaundice, and respiratory distress [Table 3]. [meajo.org]

  The association of amniotic infection syndrome and recovery of gonococci in the orogastric aspirates has been described by Blank in 1959. [33] Recovery of gonococci from orogastric aspirates of the neonate reflects contamination of the upper gastrointestinal [sudanmedicalmonitor.org]

• Chemosis

  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]

  The inflammation of the conjunctiva may cause blood vessel dilation, potentially dramatic chemosis, and excessive secretion. [slideshare.net]

  Clinical Difficult to know cause on clinical ground only Significant overlap in presentation Main findings are erythema, chemosis & purulent eyedischarge Therefore Lab studies are Important 16. [de.slideshare.net]

• Visual Impairment

  Severe visual impairment and blindness in infants: Causes and opportunities for control. Middle East Afr J Ophthalmol 2011;18:109-14. [ PUBMED ] 9. Zuppa AA, D'Andrea V, Catenazzi P, Scorrano A, Romagnoli C. [meajo.org]

  Side-effects of treatment (rarely), such as the association between oral macrolides and infantile hypertrophic pyloric stenosis (IHPS) reported in infants aged Permanent visual impairment. [patient.info]

  Global estimates of visual impairment: 2010. Br J Ophthalmol. 2011; 10:1-15. Steinkuller PG, Du L, Gilbert C, Foster A, Collins ML, Coats DK. Childhood blindness. J AAPOS. 1999; 3(1):26-32. Gul SS, Jamal M, Khan N. Ophthalmia neonatorum. [ijn.mums.ac.ir]

  (E3) I don't know, maybe the excessive use of it, like putting two drops or a little more, and it may end up causing blindness in the child or partial visual impairment. [scielo.br]

• Visual Impairment

  Severe visual impairment and blindness in infants: Causes and opportunities for control. Middle East Afr J Ophthalmol 2011;18:109-14. [ PUBMED ] 9. Zuppa AA, D'Andrea V, Catenazzi P, Scorrano A, Romagnoli C. [meajo.org]

  Side-effects of treatment (rarely), such as the association between oral macrolides and infantile hypertrophic pyloric stenosis (IHPS) reported in infants aged Permanent visual impairment. [patient.info]

  Global estimates of visual impairment: 2010. Br J Ophthalmol. 2011; 10:1-15. Steinkuller PG, Du L, Gilbert C, Foster A, Collins ML, Coats DK. Childhood blindness. J AAPOS. 1999; 3(1):26-32. Gul SS, Jamal M, Khan N. Ophthalmia neonatorum. [ijn.mums.ac.ir]

  (E3) I don't know, maybe the excessive use of it, like putting two drops or a little more, and it may end up causing blindness in the child or partial visual impairment. [scielo.br]

• 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]

  Neonates presenting with signs of conjunctivitis should have a conjunctival swab sent for Gram stain and culture. [ncbi.nlm.nih.gov]

• Conjunctival Hyperemia

  […] sac, if possible covering the whole lower conjunctival area. [sudanmedicalmonitor.org]

• Cesarean Section

  Sixty-five percent of the cases had been delivered by cesarean section, 47% and 11% had histories of maternal premature rupture of membrane (PROM) and genitourinary infection, respectively, 65% were preterm, and 61% and 32% had low weight and APGAR score [ncbi.nlm.nih.gov]

  I think, normally, it is used for vaginal birth, I don't know about cesarean section birth, normally it is vaginal, yes. [scielo.br]

  When a mother has active herpes sores at the time of delivery, a Cesarean section (C-section) is recommended to prevent serious illness in the baby. References Olitsky SE, Hug D, Plummer LS, Stahl ED, Ariss MM, Lindquist TP. [mountsinai.org]

  If a pregnant woman experiences herpes sores during the delivery time, cesarean section is highly recommended to prevent the newborn from any kind of illness. Ophthalmia Neonatorum is a serious disorder of the eye. [hxbenefit.com]

• Confusion

  […] by · Published January 28, 2011 · Updated May 3, 2013 This is one of those conditions that can generate a lot of confusion and debate among intelligent people… and is therefore fun to think about. [pedemmorsels.com]

  We felt that an alternation system would result in less confusion and possible misallocation in a busy maternity unit in a developing country than a strict randomisation of infants. [bjo.bmj.com]

  Species of the Tribes Mimeae, Neisserieae and Streptococceae Which Confuse the Diagnosis of Gonorrhoea by Smears. J. Lab Clin. Med., 28:710-714, 1943. 4. DeBord, G. G.: Organisms Invalidating the Diagnosis of Gonorrhoea by the Smear Method. J. [healio.com]

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]

  Rothenberg R (1979) Ophthalmia neonatorum due to Neisseria gonorrhoeae. Prevention and treatment. Sex Transm Dis 6 [Suppl]: 189 Google Scholar 5. Malouf DJ, Oates RK (1995) Herpes simplex virus infections in the neonate. [link.springer.com]

Any new studies of treatment of neonatal chlamydial infection would have to be done outside the United States in countries where prenatal screening and treatment of pregnant women is not routine practice. [cid.oxfordjournals.org]

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]

Outlook (Prognosis) Quick diagnosis and treatment often leads to good outcomes. [mountsinai.org]

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]

Bulletin Archive Contact Us Laurie Forlano, DO, MPH, State Epidemiologist Director, Office of Epidemiology 109 Governor Street, 6th Floor East Richmond, VA 23219 Phone: (804) 864-8141 Fax: (804) 864-8139 Contact Us by Email [vdh.virginia.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]

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), an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. [aafp.org]

1 Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. ( 30694309 ) 2019 2 Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: US Preventive Services Task [malacards.org]

Credé’s contribution to preventive medicine. Am J Dis Child 1971;121(1):1-3. U.S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010. MMWR 2010;59(No. [cps.ca]

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.