Ophthalmia neonatrum

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Neonatal Conjunctivitis

Neonatal Conjunctivitis

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  • Crede’s method of prophylaxis – application of 1% silver nitrate solution – prevents bacterial inflammation but not chlamydial or herpes infection.
  • In most countries neomycin and chloramphenicol eye drops are used instead of silver nitrate.
  • Chemosis - edema of the bulbar conjunctiva, forming a swelling around the cornea
  • Thayer-Martin Media – nessieria gonnorhea
  • Natal measures are of utmost importance as mostly infection occurs during childbirth.

Transcript

  • 1. OPHTHALMIANEONATORUMAelaf AsegedC2
  • 2. OPHTALMIA NEONATORUMIntroduction Definition- inflammation of the conjunctiva in the first 28 daysof life. Also known as Neonatal Conjunctivitis.
  • 3. Epidemiology Before introduction of silver nitrate eye drops in the late 19thcentury, approximately 10% to 15% of newborns developedbacterial conjunctivitis. Current incidence varies by the availability of obstetric care. Annual rates of gonococcal and chlamydial conjunctivitis per 1,000 livebirths are approximately 0.3 and 5, respectively, in the United States but areten times greater in parts of Africa.
  • 4. Epidemiology… The risk of corneal complications from ophthalmia neonatorum ishigher among the poor. Between 1,000 and 4,000 infants are blinded each year.
  • 5. Predisposing Factors Organisms in vagina shed during delivery Premature rupture of membranes Long delivery Few tears and low levels of IgA Trauma to epithelial barrier Prophylaxis (silver nitrate)
  • 6. Types 2 types Septic Aseptic
  • 7. Types…Aseptic – Chemical conjunctivitis mostly Silver nitrate - prophylaxis of infectiousconjunctivitis- Crede’s method ofprophylaxis not as common anymore because of the use of erythromycinointment
  • 8. Types…Septic- Bacterial, chlamydial (the most common cause), and viral infections are majorcauses Acquired by passage through birth canal
  • 9. Etiology Chemical or Microbial ChemicalSilver nitrate surface-active chemical, facilitating agglutinate gonococci and inactivating them. toxic to the conjunctiva, potentially causing a sterile neonatal conjunctivitis.
  • 10. Etiology… MicrobialChlamydia trachomatis the most common infectious cause 4-10% pregnant women infected Infants whose mothers have untreated chlamydial infections antepartum have a 30% to 40%chance of developing chlamydial neonatal conjunctivitis postpartum. reservoir- maternal cervix or urethra
  • 11. Etiology… Neisseria gonorrhea have the ability to penetrate intact epithelial cells, and once inside the cell, they divide rapidly. the most dangerous and virulent infectious cause must be absolutely excluded in every case serious consequences
  • 12. Etiology…Other bacteria Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus viridans, andStaphylococcus epidermidis. Escherichia coli, Klebsiella pneumoniae, Serratia marcescens, and Proteus,Enterobacter, and Pseudomonas species
  • 13. Etiology…Herpes simplex can cause neonatal keratoconjunctivitis rare and is associated most often with a generalized herpes simplex infection
  • 14. Incidence Gonococcal 40 per 1000LB Chlamydial 80 per 1000LB 50% has concomitant gonococcal infection Chemical Conjunctivitis- decreased with substitution of silvernitrate. Incidence from other causes is relatively rare.
  • 15. 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. Clinical…Incubation Period Chemical conjunctivitis (silver nitrate)- 1st day of life- disappearspontaneously in 2-4 days Gonococcal- 3-5 days or later Chlamydial- 5-14 days Other bacteria- longer Herpetic- within 2wks
  • 17. Clinical… Chemical Conjunctivitis mild, transient tearing Gonococcal Bilateral purulent conjunctivitis – classical (75%) More severe (hyperacute conjunctivitis) Chemosis and ulceration - perforation of cornea and endophthalmitis (inflmn. of ocular cavity & adj.structures) Rhinitis, stomatitis, arthritis, meningitis, anorectal infection, septicemia… Conjunctival membrane plus blindness
  • 18. Clinical… Chlamydial From Mild hyperemia with scant mucoid discharge Eyelid swelling, chemosis and pseudo membrane formation unilateral or bilateral watery discharge which may become more copious and purulent later Blindness-rare and slower to develop-b/s of eyelid scarring and pannus (non suppurating inflamedlymph gland) Pneumonitis, pharyngeal and rectal colonization
  • 19. Clinical… Other Bacteria Similar findings like edema of eye lids, chemosis and eye discharge. Pseudomonas is rare but can cause accelerated corneal ulceration andperforation; if left untreated endophthalmitis and death can occur.
  • 20. Clinical…Herpes simplex- Keratoconjunctivitis, generalized herpes simplex, encephalitis (low immunity) nonspecific lid edema, moderate conjunctival congestion Non-purulent, unilateral or bilateral discharge Geographic ulcers around the skin of the eye are typical Conjunctival membrane may be there
  • 21. Work Up Gram stain/ Geimsa stain of conjunctival scrapings (rule outChlamydia…intracellular inclusion bodies) Culture (Thayer-Martin/ chocolate/ blood Agar) Direct immunofluorescent antibody HSV culture if vesicles are present
  • 22. Treatment Prophylaxis Antenatal - thorough care of mother and treatment of genital infectionswhen suspected. Cesarean Delivery Natal - Topical 0.5% silver nitrate, 1% tetracycline for gonococcalinfection
  • 23. Treatment… Medical treatment Systemic treatment is mandatory as topical alone in not effective thoughhelpful acute neonatal conjunctivitis should be treated for gonococcalconjunctivitis until culture results are available
  • 24. Treatment… Treatment prior to laboratory results Topical erythromycin ointment and IV or IM third-generation cephalosporin (ceftriaxone 30-50mg/kg/d IVor IM. Max 125mg)
  • 25. Treatment… Chemical Conjunctivitis Eye is regularly flushed and the eyelids cleaned – symptoms disappearwithin 1 to 2 days
  • 26. Treatment… Gonococcal Conjunctivitis Topical administration of broad-spectrum antibiotics (gentamicineyedrops every hour)+ Systemic penicillin (penicillin G iv 2 million IU daily)OR A single dose of ceftriaxone (75-100 mg/kg/day IV or IM QID for 7days) is an alternative treatment.
  • 27. Treatment… Chlamydial Conjunctivitis Topical erythromycin eyedrops (5x/day)+ Oral erythromycin (50 mg/kg/d divided QID)Since the efficacy of systemic erythromycin therapy is approximately 80%,a second course sometimes is required.
  • 28. Treatment… Herpetic Conjunctivitis Acyclovir eye ointment Systemic acyclovir 30 mg/kg/day IV TID, for 14 days up 21 days (insever cases)
  • 29. Reference Ophthalmology.-.A.Pocket.Textbook.Atlas.2nd.ed.2007 Duanes.Ophthalmology.2007.Edition Wikipedia