This document discusses ophthalmia neonatorum, which is inflammation of the conjunctiva in newborns during the first 28 days of life. It can be caused by infection transmitted from the mother's birth canal. Without silver nitrate eye drops, 10-15% of newborns were infected historically. Today the most common causes are Chlamydia trachomatis and Neisseria gonorrhoeae. Symptoms vary but include eye redness, swelling, and discharge. Treatment involves topical and sometimes systemic antibiotics. Proper prenatal care and treatment of maternal infections can help prevent this condition.

1. OPHTALMIA NEONATORUM
Introduction
• Definition- inflammation of the conjunctiva in the first
28 days of life.
• Also known as Neonatal Conjunctivitis.
• Neonatal conjunctivitis, also known as ophthalmia
neonatorum, is a form of conjunctivitis and a type of
neonatal infection contracted by newborns during
delivery. The baby's eyes are contaminated during
passage through the birth canal from a mother infected
with either Neisseria gonorrhoeae or Chlamydia
trachomatis

2. Epidemiology
• Before introduction of silver nitrate eye drops in the late 19th
century, approximately 10% to 15% of newborns developed
bacterial conjunctivitis.
• Current incidence varies by the availability of obstetric care.
– Annual rates of gonococcal and chlamydial conjunctivitis
per 1,000 live births are approximately 0.3 and 5,
respectively, in the United States but are ten times greater
in parts of Africa & india.
– The risk of corneal complications from ophthalmia
neonatorum is higher among the poor.
– Between 1,000 and 4,000 infants are blinded each year.

3. 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)

4. Types…
Aseptic –
• Chemical conjunctivitis mostly
• Silver nitrate - prophylaxis of infectious
conjunctivitis
- Crede’s method of prophylaxis
• not as common anymore because of the use of
erythromycin ointment.
Septic-
• Bacterial, chlamydial (the most common cause), and
viral infections are major causes
• Acquired by passage through birth canal

5. Etiology
• Chemical or Microbial
–Chemical
Silver nitrate
– surface-active chemical, facilitating
agglutinate gonococci and inactivating
them.
– toxic to the conjunctiva,
– potentially causing a sterile neonatal
conjunctivitis.

6. Etiology…
• Microbial
Chlamydia 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

7. 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

8. Etiology…
Other bacteria
–Staphylococcus aureus, Streptococcus
pneumoniae, Streptococcus viridans, and
Staphylococcus epidermidis.
–Escherichia coli, Klebsiella pneumoniae,
Serratia marcescens, and Proteus, Enterobacter,
and Pseudomonas species

9. Clinical
• Difficult to know cause on clinical ground only
• Significant overlap in presentation
• Main findings are erythema, chemosis &
purulent eye discharge
• Therefore Lab studies are Important

10. Clinical…
Incubation Period
– Chemical conjunctivitis (silver nitrate)- 1st day of life- disappear spontaneously in 2-4 days
– Gonococcal- 3-5 days or later
– Chlamydial- 5-14 days
– Other bacteria- longer
– Herpetic- within 2wks

12. 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 inflamed
lymph gland)
– Pneumonitis, pharyngeal and rectal colonization

13. Treatment
• Prophylaxis
–Antenatal - thorough care of mother and treatment
of genital infections when suspected.
–Cesarean Delivery
–Natal - Topical 0.5% silver nitrate, 1% tetracycline
for gonococcal infection

14. Treatment…
• Treatment prior to laboratory
results
– Topical erythromycin ointment and
– IV or IM third-generation
cephalosporin (ceftriaxone 30-
50mg/kg/d IV or IM. Max 125mg)

15. Treatment…
• Gonococcal Conjunctivitis
– Topical administration of broad-spectrum antibiotics
(gentamicin eyedrops 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 7 days) is an alternative treatment.

16. 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.

18. Neonatal Jaundice
(Hyperbilirubinemia)
• Definition: Hyperbilirubinemia refers to an excessive level of accumulated bilirubin in the
blood and is characterized by jaundice, a yellowish discoloration of the skin, sclerae,
mucous membranes and nails.
• Neonatal Jaundice(also called Newborn jaundice) is a condition marked by high levels of
bilirubin in the blood.

19. NJ - 19

20. Neonatal Jaundice
• Visible form of bilirubinemia
–Newborn skin >5 mg / dl
• Occurs in 60% of term and 80% of preterm neonates
• However, significant jaundice occurs in 6 % of term babies
• 6-10% require phototherapy/ other therapeutic options.

21. Clinical assessment of jaundice
(Kramer’s staging)
Area of body Bilirubin levels
mg/dl (*17=umol)
Face Zone-1: 4-6
Upper trunk Zone-2: 6-8
Lower trunk & thighs
Arms and lower legs Zone-3: 8-12
Palms & soles Zone-4 :12-14
Zone-5 :>15

22. Physiological jaundice
Characteristics
• Appears after 24-72 hours
• Maximum intensity by 3th-5th day in term & 7th day in preterm
• Serum level less than 15 mg / dl
• Clinically not detectable after 14 days
• Disappears without any treatment

23. Pathological jaundice
• Appears within 24 hours of age
• Increase of bilirubin > 5 mg / dl / day
• Serum bilirubin > 15 mg / dl
• Jaundice persisting after 14 days
• Stool clay / white colored and urine staining clothes yellow
• Direct bilirubin> 2 mg / dl

24. Causes of jaundice
Appearing within 24 hours of age
• Hemolytic disease of NB : Rh, ABO
• Infections: TORCH, malaria, bacterial
• G6PD deficiency

25. Causes of jaundice
Appearing between 24-72 hours of life
• Physiological
• Sepsis
• Polycythemia
• Intraventricular hemorrhage
• Increased entero-hepatic circulation

26. Causes of jaundice
After 72 hours of age
• Sepsis
• Cephalhaematoma
• Neonatal hepatitis
• Extra-hepatic biliary atresia
• Breast milk jaundice
• Metabolic disorders (G6PD).

27. Risk factors for jaundice
JAUNDICE
• J - jaundice within first 24 hrs of life
• A - a sibling who was jaundiced as neonate
• U - unrecognized hemolysis
• N – non-optimal sucking/nursing
• D - deficiency of G6PD
• I - infection
• C – cephalhematoma /bruising
• E - East Asian/North Indian

28. Therapeutic Management
• Purposes: reduce level of serum bilirubin and prevent bilirubin toxicity
• Prevention of hyperbilirubinemia: early feeds, adequate hydration
• Reduction of bilirubin levels: phototherapy, exchange transfusion,
• Drugs Use of Phenobarbital promote liver enzymes and protein synthesis.

29. Babies under phototherapy
Baby under conventional phototherapy Baby under triple unit intense phototherapy

30. Thank You!