Ophthalmia neonatorum bondi

paediatric class year 4.1. ophthalmia neonatorum is wholly preventable thanks to modern meds and improving nursing and medical care.

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.

4. 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.

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

6. 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 i nfection of STI with their respective healthcare providers in order to prevent the baby from all kinds of infections during delivery.

7. 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

8. 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

9. 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

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

11. 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

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. NDATENDA

21. 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 Plans By Matt 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

22. 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.