Definition

Neonatal conjunctivitis, or ophthalmia neonatorum, is an eye inflammation occurring in newborns within the first 30 days of life. It can be caused by chemical reactions, bacterial or viral infections. The incidence of ophthalmia neonatorum varies from 1-2%, depending on the socioeconomic status of the area. In the United States, Chlamydia species are the most frequent cause, responsible for 2-40% of cases. No specific reports are linking the condition to the sex of the baby.

Causes

Ophthalmia neonatorum can be caused by several microorganisms, including:

• Chlamydia trachomatis: This parasite can be found in the mother's cervix and urethra. Babies born to infected mothers have a high risk (25-50%) of developing ophthalmia neonatorum.
• Neisseria gonorrhoeae: These bacteria are located in the mother's cervix and urethra and typically infect the baby's conjunctiva during the birth process due to their proximity to the birth canal. N. gonorrhoeae can invade intact cells and replicate within them, historically leading to blindness in newborns until the advent of antibiotics.
• Other bacteria: Staphylococcus aureus and Streptococcus pneumoniae account for 30-50% of ophthalmia neonatorum cases.
• Herpes simplex virus: Although rare (1% of cases), this virus is highly infectious. Mothers with herpes simplex infections are advised to undergo cesarean sections to prevent transmission during vaginal birth.

Microorganisms in the mother's vagina: Infections from Chlamydia sp., Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria gonorrhoeae can occur during the birth process. These infections are generally more severe in newborns due to their underdeveloped immune systems.

Risk Factor

Several factors increase the risk of ophthalmia neonatorum, including:

• The mother has sexual transmitted infections or HIV
• Exposure to infectious microorganisms
• Large birth weight
• Lack of prophylaxis in newborns
• Premature rupture of membranes
• Ocular injuries during childbirth
• Premature birth
• Lack of regular prenatal care in pregnancy

Symptoms

Symptoms depend on the infecting microorganism:

• Chemical-induced ophthalmia neonatorum generally occurs with symptoms appearing within 24 hours and usually do not require specific therapy.
• Symptoms in infections caused by Chlamydia sp. typically emerge 5-14 days after birth, including swollen eyes and thick, white mucus. The infection can be severe and may also affect the lungs and nasopharyngeal organs.
• Symptoms in infections caused by N. gonorrhoeae typically appear 2-5 days after birth, including severe eyelid inflammation and greenish-yellow mucus. Immediate treatment is necessary.
• Ophthalmia neonatorum caused by herpes simplex virus infection typically have the symptoms manifest 1-2 weeks after birth.
• In other bacterial infections, symptoms generally appear on the fifth day after birth and do not usually require treatment.

Diagnosis

The doctor will inquire about the baby's symptoms, such as the color and amount of mucus found in the eyes and the baby’s medical history. An examination of the eye mucus will be conducted, and if symptoms persist for more than 48 hours, the mucus will be analyzed to identify the microorganism for appropriate treatment. If inflammation is evident, antibiotics may be administered before receiving test results. Additional tests, such as blood tests and chest x-rays, may be performed if necessary.

Management

Treatment of ophthalmia neonatorum involves the use of antibiotic drops, ointments, or intravenous infusions. Cleaning the baby's eyes with sterile fluid can help enhance the absorption of these antibiotics. For blocked tear ducts, gently massaging the area between the eyes and nose may help.

Specific treatments include:

• Chlamydia sp. infection: Treated with oral or intravenous antibiotics for 14 days.
• N. gonorrhoeae infection: Treated with antibiotics administered intravenously or intramuscularly and irrigation with sterile fluids for 7-14 days.
• Chemical-induced infection: Typically resolves within 24-36 hours without specific medication.
• Other bacterial infections: Treated with antibiotic drops and warm compresses.

The choice of antibiotics depends on the health facility's protocols.

Complications

Ophthalmia neonatorum generally responds well to treatment, leading to better outcomes. Antibiotics significantly reduce complications, especially those related to Neisseria gonorrhoeae. However, untreated ophthalmia neonatorum can result in corneal laceration, endophthalmitis (infection of the inner eye), and serious infections in newborns. About 10-20% of babies with Chlamydia sp. infections also develop pneumonia. Infections caused by the herpes simplex virus can lead to severe eye inflammation, scarring, and potential involvement of the central nervous system.

Prevention

• Regular hand washing is crucial to prevent the transmission of ophthalmia neonatorum, especially before and after touching the baby.
• Pregnant women should undergo routine examinations to detect sexually transmitted infections (STIs) like herpes simplex, gonorrhea, and chlamydia to reduce the risk of ophthalmia neonatorum.
• Mothers with herpes infections should consult with an obstetrician before giving birth to prevent viral transmission to the baby.
• Regular health check-ups with a doctor are recommended.

When to see a doctor?

Immediate medical attention is necessary if your baby exhibits red eyes, swollen eyelids, and thick white or greenish-yellow eye mucus 5-12 days after birth. Regular prenatal check-ups are essential to detect and treat diseases early and effectively.

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