Opthalmia Neonatorum

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Ophthalmia Neonatorum
(Newborn Conjunctivitis, Neonatal Conjunctivitis)
Definition
Ophthalmia neonatorum is conjunctivitis (inflammation of the surface or covering of the eye because of infectious or non-infectious causes) that occurs in the newborn. Any eye infection that occurs in the first month of a baby’s life can be classified as ophthalmia neonatorum. While an infection has the potential to damage the delicate eye of an infant, there are a number of ways these infections can be prevented.
Additionally, effective treatment is available for infants that do develop an eye infection. If you suspect your baby may be at risk for an infection, or may have an eye infection, you should contact your doctor immediately.
Causes
The cause of the conjunctivitis may be simply an irritation in the eye, or a blocked tear duct. However, bacteria can also cause an infection in the eye. The most common types of bacteria that cause infection in the infant’s eye come from the mother’s birth canal, and are passed to the infant during delivery. These infections can include:
• Sexually transmitted diseases (STDs) : The most common bacteria passed to infants during delivery are due to STDs from the mother’s birth canal. If untreated, many of these infections can cause serious damage to the infant’s eye. STDs that can cause eye damage include:
o Chlamydia
o Gonorrhea
o The virus that causes oral and genital herpes
• Skin bacteria such as Staphylococcus aureus
• Bacteria from the mother’s gastrointestinal tract, such as Pseudomonas
Risk Factors
The biggest risk factor for developing ophthalmia neonatorum is a maternal infection or STD at the time of delivery. Unfortunately, with some infections, the mother may not have any symptoms during delivery and still be able to transmit the infection. If you are pregnant, it is important to discuss any STDs that you have, or had in the past. You and your doctor can develop a plan to protect your baby from infections during delivery.
Symptoms
The most common is redness and swelling of the conjunctiva in the newborn. If your baby has this or any of the other symptoms described below, see your baby's pediatrician. Some of the other symptoms of ophthalmia neonatorum include:
• Drainage and discharge from the eye; it may be watery or thick and pus-like
• Swollen eyelids
Diagnosis
If your baby’s pediatrician suspects ophthalmia neonatorum they will first perform an eye examination. The doctor will look at your baby’s eyes to check for anything that may be irritating the eye, and to see if any damage has occurred. The doctor may look at the baby’s tear ducts to see if they are blocked. The doctor may also want to take a sample of any discharge to determine what type of bacteria or virus is causing the infection.
Treatment
Since the potential for serious eye damage to the infant is so great, it is standard treatment in US hospitals to give infants antibiotic eye drops or ointment immediately following delivery. This helps prevent the development of an eye infection even if the mother shows no symptoms of infection.

In cases where conjunctivitis does develop, the treatment of ophthalmia neonatorum depends on the cause:
Blocked Tear Duct
In cases of ophthalmia neonatorum that are due to a blocked tear duct, the doctor may recommend warm compresses and gentle massage to the area to help unclog the duct.
Irritation
Ophthalmia neonatorum due to irritation usually resolves on its own in a few days. In some cases, the irritation may be due to the antibiotic given after delivery. Silver nitrate, which was often used in the past to prevent eye infection, can cause irritation in the baby’s eye. Many hospitals now use other types of antibiotics to avoid this irritation.
Bacteria
Infants that have an eye infection due to bacteria are given antibiotics. These antibiotics may be given as topical drops or ointments, orally, or as an injection. In addition, the eye may be irrigated to remove the discharge.
Fortunately, since hospitals today have such effective prevention measures, bacterial cases of ophthalmia neonatorum are rare. And when they do occur, they are usually identified quickly. Antibiotic treatment is very effective and generally, the infection resolves rapidly. If you suspect that your infant may have an infection in the eye, it is important to call your baby’s doctor as soon as possible to receive prompt treatment.
Prevention
The best prevention of ophthalmia neonatorum is treatment of any sexually transmitted diseases in the mother prior to labor and delivery.
• In most cases, effective treatment of the mother before the time of delivery can prevent the transmission of infection to the newborn.
• For mothers with active genital herpes lesions at the time of delivery, a cesarean section can prevent the infant from getting the infection.
An open, honest relationship with your doctor is important during your pregnancy. Disclosure of your full medical history can help protect your baby from infection.