Session 5-Ophthalmikjdfa Neonatorum-1.pptx

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1. Ophthalmia Neonatorum 1

2. Learning tasks At the end of this session, students are expected to be able to: Define ophthalmia neonatorum Explain risk factors/ aetiology of ophthalmia neonatorum Explain clinical features and complications of ophthalmia neonatorum Perform clinical assessment for a patient with ophthalmia neonatorum 2

3. Learning tasks Establish provisional and differential diagnoses of a patient with ophthalmia neonatorum Determine appropriate investigations to be performed to patients with ophthalmia neonatorum Treat, conduct follow up and refer patients with ophthalmia neonatorum as appropriate Provide preventive measures to patients with ophthalmia neonatorum 3

4. Activity: Brainstorming What is Ophthalmia Neonatorum ? 4

5. Definition of Ophthalmia Neonatorum Is an acute inflammation of the eye affects newborns during the first 28 days of life ( MoHCDGEC , 2019). Also called Neonatal conjunctivitis Usually both eyes are affected. 5

6. Risk factors Newborns delivered by mother with untreated STIs like gonococcus and chlamydia. The disease occurs within hours or a day or two. Gonococcal infection often becomes symptomatic within the first 5 days of life. 6

7. Causes Bacterial-Most common: Neisseria gonorrhoeae Chlamydia trachomatis Staphylococcus spp. Chemical such as use of silver nitrate eye drops-found to be toxic to the conjunctiva causing neonatal conjunctivitis Viral i.e. herpes infection 7

8. The pathophysiology The infection usually transmitted to a baby at birth as the maternal cervix and urethral mucosa act as a reservoir for these bacteria. The underlying pathology is infection of outer eye. Inflammatory reaction cause red eyes, swollen and draining pus. If the problem develop while the baby was hospitalized or more than one baby with same problem from the same ward is seen within a two-day period, suspect a nosocomial infection 8

9. The clinical features Mild-moderate conjunctivitis: Reddish. Eyes swollen or draining some pus Severe conjunctivitis: Purulent and copious discharge from the eyes Massive oedema and redness of eyelids 9

10. 10

11. Complications It can rapidly spread to: Corneal ulcer Corneal perforation Corneal scarring endophthalmitis blindness 11

12. Investigations Eye swab for gram stain, culture and sensitivity 12

13. Management General management: Wash hands before and after procedure and instruct the mother to do so. Irrigate eyes with normal saline or boiled water 1-2 hourly until discharge is cleared. Show the mother how to irrigate the eyes. Show the mother how to put ointment. 13

14. Management cont … General management, cont.. Check mother and partner(s) for gonorrhea or chlamydia and treat accordingly Review all patients after 3 days, no matter what specific treatment received. If no more discharge on 3 rd day, stop systemic treatment (Erythromycin). 14

15. Management cont … Specific management: Bilateral or unilateral reddish and swollen eyelids with purulent discharge (and no microbiology results available): Ceftriaxone 50mg/kg IM as a single dose (not indicated in case of jaundice) + Erythromycin syrup 50mg/kg/ day orally for 14 days. Alternative for Ceftriaxone is Kanamycin IM (15-20mg/kg/day divided 12 hourly) or Spectinomycin IM(1-2g/day divided 12 hourly) and alternative for Erythromycin is Cotrimoxazole. 15

16. Management cont.. If known maternal gonococcal infection or gram negative intracellular diplococci identified in conjunctival swab or if it known chlamydial Ophthalmia: Treat specific organism Conjunctivitis due to other bacteria usually responds to topical ointments such as, tetracycline, erythromycin or chloramphenicol given at least 4 hourly for 7-14 days. 16

17. prognosis Neonatal conjunctivitis usually respond well with and antibiotics and hence prognosis is good. 17

18. Preventive measures Screening for STIs during pregnancy and management according to findings including partner management. Routine 1% Tetracycline ointment to newborns at birth. 18

19. Key points Is an acute inflammation of the eye affects newborns during the first 28 days of life. The most common causative organisms includes: Neisseria gonorrhoeae, Chlamydia trachomatis and Staphylococcus spp. The infection usually transmitted to a baby at birth. Severe conjunctivitis should be treated with systemic broad spectrum antibiotics. 19

20. Reference WHO (2013). Hospital Care for Children: Guideline for the Management of Common Childhood Illnesses, 2 nd Edition. MoHCDGEC (2018). Standard Treatment Guidelines and National Essential Medicines List: For Children and Adolescents (1 st Ed). Dodoma. MoHCDGEC (2017). Standard Treatment Guidelines and National Essential Medicines List: Tanzania Mainland (4 th Ed). MoHCDGEC , (2019). National Guideline for Neonatal Care and Establishment of Neonatal Care Unit, RCH Section, Dodoma. 20

21. Reference cont … WHO (2003). Managing Newborn Problems: A guide for doctors, nurses, and midwives. Department of Reproduction Health and Research, World Health Organization, Geneva . Stanfield, P. et al, (2005), Child Health: A manual for Medical and Health Workers in Health Centres and Rural Hospitals, 3 rd Ed, AMREF, Nairobi. Kenya. 21