Ophthalmia neonatorum is conjunctivitis occurring in the first 28 days of life. It is usually caused by bacterial infections transmitted from the mother during delivery, such as Neisseria gonorrhoeae and Chlamydia trachomatis. Signs and symptoms depend on the causative organism but can include eye redness, swelling, and discharge. Treatment involves antibiotic therapy guided by diagnostic testing. Complications may include keratitis, vision impairment, or systemic infection. Prompt and appropriate treatment is important to prevent permanent eye damage.

1. Ophthalmia Neonatorum/
neonatal conjunctivitis
Sasha Bondi
BSc NS 4.1
UZ-CHS

2. Overview
• Definition
• Aetiology
• Risk factors
• Signs and Symptoms
• Diagnosis
• Treatment
• Complications
• Prognosis
• Nursing Management
• Nursing Diagnoses

3. Definition
• Ophthalmia neonatorum(ON) refers to conjunctivitis occurring in the
first 28 days of life.
• It is rare and acute
• The infection is acquired from the mother during delivery
• It must be treated immediately to prevent permanent eye damage or
blindness.

5. Aetiology
• There are types
• Infectious
• Non-infectious
• Infectious
• caused by bacterial infections such as N.gonorrhoeae, C.trachomatis
(most common causes) present in the birth canal of an infected
woman.
• Also caused by S.aureus, Strep pneumonia, Pseudomona
spp.,Haemophilus spp. And other gram negative bacteria
• Viral infections less common, can be caused by HSV, adenovirus,
enterovirus.

6. CONT……
• Non-infectious
• ON caused by chemical irritants like silver nitrate (used as
prophylaxus for ON in some countries)

7. Risk factors
• Patients infected with STI, during the delivery time are more at risk of
getting affected with ON.
• In rare cases, a pregnant woman might not be suffering from any
symptom but may still unknowingly transmit the bacteria in the
newborn.
• Pregnant women are highly recommended to discuss any previous
infection of STI with their respective healthcare providers in order to
prevent the baby from all kinds of infections during delivery.

8. Signs and Symptoms
• Gonorrhoeal
Typical onset 2-5 days after birth
Hyper-acute conjunctival injection and chemosis
Local inflammation and mucopurulent discharge (severe)
May be associated corneal ulceration and perforation

9. CONT……
• Chlamydial
5-12 days after birth
Unilateral/bilateral watery discharge which becomes copious and
purulent later on
May be associated pre-septal cellulitis, less commonly rhinitis, otitis,
pneumonitis
Eyes usually less inflamed than in case of Gonococcal infection

10. CONT……
• Viral
Onset is acute, 1-14 days after birth
Unilateral/bilateral serosanguinous discharge +/- vesicular skin
lesions
May include keratitis, anterior uveitis, retinitis and rarely optic
neuritis
Uncommonly systemic infection can cause jaundice,
hepatosplenomegaly, pneumonitis, meningoencephalitis and DIC

11. CONT….
• Chemical
Mild irritation
Tearing, redness in baby who has been administered AgNO₃ with-in
preceding 24-48 hours

12. Diagnosis
• Culture of drainage from eye to determine if viral/bacterial
• NAAT to determine in Gonococcal/chlamydial
• History of STI in mother
• Maternal investigations, cervical swab for occult STI
• SIT lamp exam to determine any kind of injury on the surface of
eyeball
• Differential diagnoses
 Keratitis (bacterial, viral, fungal)
 Nasolacrimal duct obstruction (NLDO)
 Dacrocystitis (infection of lacrimal sac 2ndry to NLDO)
 Glaucoma

14. Treatment
• If Gonococcal suspected refer immediately
• Early and appropriate treatment key to prevent consequent severe
sight impairment.
• Appropriate to start infant on broad-spectrum antibiotic treatment
prior to results, or syndromic management till results are out.
• For bacterial treatment guided by organism
• If there is corneal involvement infant should be hospitalised and
treated for bacterial keratitis.

15. CONT…..
• Chlamydial
Erythromycin 50 mg/kg/day P.O divided into 4 doses daily x 2/52
Alternative Azithromycin 20 mg/kg/day P.O 1 dose daily x 3/7
For either monitor for infantile hypertrophic pyloric stenosis
This is common in babies less than 6 weeks old
• Gonococcal
Hospitalise and assess for disseminated disease
Hourly saline lavage to remove discharge
Ceftriaxone 25-50mg/kg/day IV or IM single dose
Do not exceed 125 mg
Other bacterial infections topical antibiotics
Pseudomonas spp. Topical and system. isolate

16. CONT…..
• Viral
Baby hospitalised
Acyclovir IV full-term baby 45-60mg/kg/day in divided doses for 14
days if disease is limited, 21 days in disseminated disease in addition
to topical antiviral preps.
• Chemical
Self limiting
Review after 24 hours to confirm it is indeed chemical

17. Complications
• Mainly related to Gonococcal, others benign.
• Keratitis
• Conjunctival scarring
• Superior corneal pannus (an abnormal layer of fibrovascular tissue or
granulation tissue)
• S.E of treatment (rare)
• i.e. associated with oral macrolide treatment and infantile
hypertrophic pyloric stenosis in less than 6 weeks
• Permanent visual impairment
• Overwhelming systemic infection may occur - e.g., chlamydial
pneumonia, disseminated herpes simplex
• Pseudomonas spp (rare) causes keratitis, in disseminated ultimately
lead to death

18. Prognosis
• Chlamydial-80% fully recover
• Bacterial rarely fails to respond to treatment if prompt and
appropriate, missed infections may lead to sever sight impairment or
even death
• Viral- ocular prognosis can be poor and systemic sequelae can be fatal
• Chemical- good, full spontaneous recovery, expected after 24-36
hours

19. Prevention
• Prenatal maternal screening for STIs
• Prenatal maternal treatment of detected STIs
• Prophylactic treatment of neonates:- topical erythromycin, TEO
• Topical prophylaxis not effective in preventing ON due to chlamydial
infection

20. Nursing management
• Provide health education
• Counsel mother
• Offer HIV testing and counselling
• Advise to return after 3 days for follow up or earlier if need arises

21. Nursing diagnosis
• Hyperthermia related to inflammatory process as evidenced by an
increase in body temperature, warm skin and tachycardia
• Ineffective breathing pattern related to increase in secretions in
airway as evidenced by chest in-drawing
• Interrupted breast-feeding related to neonates present illness as
evidenced by separation of mother from infant
• Risk for impaired parent/infant attachment related to neonates
physical illness and hospitalisation

23. References
• Chlamydial and Gonococcal Infections in Infants and Children; Clinical
Infectious Diseases Vol 53 Issue 3 p S99 - S102
• Matejcek A, Goldman RD; Treatment and prevention of ophthalmia
neonatorum. Can Fam Physician. 2013 Nov59(11):1187-90.
• https://nurseslabs.com/neonatal-sepsis-nursing-care-plansNeonatal
Sepsis Nursing Care PlansByMatt Vera, BSN, R.N. accessed 1-8-2019
• https://www.hxbenefit.com/ophthalmia-neonatorum.html accessed
1-8-2019
• https://patient.info/doctor/Ophthalmia-Neonatorum accessed 1-8-
2019
• https://www.ncbi.nlm.nih.gov/pubmed?term=%22Cent+Afr+J+Med%
22[jour] accessed 1-8-2019

24. GLossary
Keratitis is an inflammation or irritation of the cornea (the transparent membrane covering the iris and pupil)
Anterior uveitis is the inflammation of the iris;
Retinitis is inflammation of the retina in the eye
Optic nerve carries images of what the eye sees to the brain. When this nerve become swollen or inflamed, it is called optic
neuritis.
Meningoencephalitis inflammation and swelling of both the meninges and brain.
Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small
blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts
of the body.
NAAT- nucleic acid amplified test
Dacryocystitis is an infection of the lacrimal sac, secondary to obstruction of the nasolacrimal duct at the junction of lacrimal
sac.
Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged. It's
usually caused by fluid building up in the front part of the eye, which increases pressure inside the eye.
Pyloric stenosis is a thickening or swelling of the pylorus — the muscle between the stomach and the intestines
Pannus is an abnormal layer of fibrovascular tissue or granulation tissue. Common sites for pannus formation include over
the cornea, over a joint surface, or on a prosthetic heart valve.