OPTHALMIA NEONATORUM.pptx

Ophthalmia Neonaturum

1. OPHTHALMIA NEONATORUM Presenter: Prakash Khanal INTERN, CMC-TH

2. Introduction Opthamia Neonatorum is B/L inflammation of the conjuctivities of an infant less than 30 days old. It is a Preventable disease occurring usually as a result of carelessness during the time of birth. Any discharge or even watering from eyes in first week of life is suspicious of Opthamia Neonatorum , as tears are not formed till then.

3. ETIOLOGY Source and mode of Infection Infection usually occurs mainly in three ways: Before Birth, During Birth , After Birth. Before Birth: Via infected liquor amnii in mothers with ruptured membrane During Birth: From infected Birth Canal During Vaginal Delivery After Birth: - During 1 st Bath, or From soiled clothes, fingers with infected lochias .

4. ETIOLOGY cont …. Causative Agents: - Chemical Cause: Silver Nitrate, Antibiotics used for Prophylaxis - Gonococcal Infection: has ability to penetrate intact epithelial cells, once inside the cells,divides rapidly - Other bacterial infections including Staphylococcus aureus , Hemophilus species , Streptococcus hemolyticus , Streptococcus pneumonia, E coli, Klebsiella , Proteus

5. Chlamydia trachomatis serotype D to K: Most common infectious cause of Neonatal Inclusion Conjuctivitis (Chlamydia trachomatis serotype D to K Causes Neonatal Inclusion Conjuctivitis ) - Herpes simplex Opthalmia neonatorum Caused by Herpes Simplex virus Usually HSV-II . Can cause Neonatal keratoconjunctivis

6. Incubation Period Chemical Cause: 6 hours Gonococcal Infection: 2 to 5 days Other bacterial: 5 to 8 days Chlamydia trachomatis: 5 to 14 days Herpes simplex Opthalmia neonatorum : 6 to 15 days

7. Clinical Features Pain Tenderness Conjunctival Discharge: Gonococcal : Purulent Discharge Chlamydial: Watery/ Mucopurulent Viral: Non-purulent, watery Conjunctival Hyperemia & Chemosis

8. Clinical Features conti .. Conjunctival Papillary Response in HSV, Chlamydial infection(Follicular response is absent as newborn has immature lymphoid) Cornial Involvement: Usually Rare but may occurs in HSV which can cause Keratitis, can complicate to Corneal ulceration & Opacity Eyelids: Swelling, Vesicle formation in case of HSV

9. Investigations Giemsa Staining: Conjunctival scrappings can be used to rule out Chlamydial infection(Chlamydia shows inclusion bodies on Giemsa staining) Culture : Thayer Martin Media, Blood agar, Choclate agar Direct Immunofluorocent Antibody

10. PROPHYLAXIS Antenatal : thorough care of mother and treatment of genital infections when suspected . Natal : - Delivery under hygienic condition taking all aseptic measures, Cesarean mode of delivery - Closed eyelids of newborn thoroughly cleansed and dried.

11. Postnatal : - Use of 1% tetracycline ointment or 0.5% erythromycin ointment into the eyes of babies immediately after bith to prevent bacterial and chlamydial ophthalmia neonaturum - Single injection of Ceftriaxone 50mg/kg IM or IV (not more than 125 mg) to infants born to mothers with untreated gonococcal infection

12. TREATMENT Systemic Treatment is mandatory as topical therapy alone is not effective though helpful Acute Neonatal conjunctivitis must be treated as gonococcal until culture reports are obtained Until lab reports are available, Topical erythromycin ointment and IM or IV Ceftriaxone 30 to 50 mg/kg/day (max 125mg) is given

13. TREATMENT cont …. Chemical Ophthalmia Neonaturum : Usually Self limiting condition, doesn’t require any treatment, but regular saline wash can be done, symptoms disappears within 1 to 2 days

14. TREATMENT cont …. Gonococcal Conjuctivitis : Topical Broad-spectrum antibiotics, Gentamycin 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 for 7 days)

15. TREATMENT cont …. Neonatal Inclusion Conjunctivitis(Chlamydial) : Topical Erythromycin Eyedrop 5 times a day + Oral Erythromycin 50mg/kg/day in divided QID

16. TREATMENT cont …. Herpetic Conjunctivitis : -Acyclovir Eye Ointment -Systemic Acyclovir 30mg/kg/day IV TID For 14 days upto 21 days in severe cases.

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