Ophthalmia neonatorum is the medical term for conjunctivitis that appears within the first month of a newborn’s life. It is a classification for inflammation of the conjunctiva, the thin mucous membrane lining the inside of the eyelids and covering the white part of the eye. This condition can range from a mild, temporary irritation to a serious infection that requires immediate medical intervention.
Causes and Types of Neonatal Conjunctivitis
Chemical Conjunctivitis
Chemical conjunctivitis is a less common form of this condition, resulting from a reaction to prophylactic eye drops administered at birth. Historically, silver nitrate solution was a primary cause of this irritation. The inflammation from this chemical exposure is mild and resolves on its own without specific treatment.
Bacterial Conjunctivitis
Bacterial infections are a more serious cause of ophthalmia neonatorum, with pathogens often transmitted from the mother during birth. Neisseria gonorrhoeae and Chlamydia trachomatis are two sexually transmitted bacteria that can lead to severe conjunctivitis. Gonococcal conjunctivitis is particularly aggressive and can cause significant eye damage if not treated promptly, while chlamydial conjunctivitis is the most common bacterial cause. Other bacteria, such as Staphylococcus aureus and Streptococcus pneumoniae, can also cause infections, which are less severe but still require medical treatment.
Viral Conjunctivitis
Viral causes of ophthalmia neonatorum are less frequent, with Herpes Simplex Virus (HSV) being the main concern. HSV can be transmitted to the baby during birth if the mother has an active genital herpes infection. This form of conjunctivitis can be part of a more widespread and serious neonatal herpes infection.
Recognizing the Signs and Symptoms
The most common signs of ophthalmia neonatorum are redness in the whites of the eyes, swollen eyelids, and discharge. The type of discharge can offer clues to the cause; it may be watery or a thick, pus-like substance. These symptoms can appear in one or both eyes.
The timing of when symptoms first appear is a significant indicator of the underlying cause. Chemical conjunctivitis manifests within a few hours of the application of eye drops. Gonococcal conjunctivitis appears between two to five days after birth, while chlamydial conjunctivitis has a longer incubation period, with symptoms starting between five and fourteen days after delivery.
Medical Diagnosis and Treatment Protocols
A healthcare provider diagnoses ophthalmia neonatorum through a physical examination of the newborn’s eyes. To determine the specific cause, a swab of the eye discharge is often collected for laboratory analysis to identify any bacteria or viruses.
Treatment for ophthalmia neonatorum is tailored to the identified cause. Chemical conjunctivitis resolves on its own within a few days and does not require medication. For bacterial infections, gonococcal conjunctivitis is a medical emergency requiring hospitalization for intravenous or intramuscular antibiotics, such as ceftriaxone. Chlamydial conjunctivitis is treated with oral antibiotics, like erythromycin, as the infection can also be present elsewhere in the infant’s body.
Other less severe bacterial infections may be managed with antibiotic eye drops or ointments. If a viral cause like HSV is identified, antiviral medications will be prescribed. Prompt medical intervention helps prevent complications such as corneal damage and potential vision loss.
Proactive Prevention Strategies
Preventing ophthalmia neonatorum begins with prenatal care. Screening pregnant individuals for sexually transmitted infections like gonorrhea and chlamydia is standard practice, and treating any detected infection during pregnancy reduces the risk of transmission to the infant.
Another preventive measure is the application of a prophylactic antibiotic eye ointment, such as erythromycin, to newborns shortly after birth. This practice is effective in preventing gonococcal conjunctivitis and has significantly reduced the incidence of severe bacterial ophthalmia neonatorum.