Ophthalmia neonatorum
Template:Ophthalmia neonatorum
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [4]
Synonyms and keywords: Neonatal Conjunctivitis
Overview
Ophthalmia neonatorum is a form of conjunctivitis 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. Typical treatment is silver nitrate drops. If left untreated it can cause blindness.
Ophthalmia neonatorum, also known as neonatal conjunctivitis, can also be caused by other bacteria, viruses, and chemical irritants (such as silver nitrate). Thus, silver nitrate is not used very often, anymore, because it can cause chemical conjunctivitis, which usually clears up within 2 to 4 days. In most countries neomycin and chloramphenicol eye drops are being used instead.
Ophthalmia neonatorum due to gonococci (Neisseria gonorrhoeae) typically manifests in the first 5 days of life and is associated with marked bilateral purulent discharge. In contrast, conjunctivitis secondary to infection with chlamydia (Chlamydia trachomatis) produces conjunctivitis after day 3 of life, but may occur up to 2 weeks after delivery. Babies infected with chlamydia may develop pneumonitis (chest infection) at a later stage (range 2 weeks - 19 weeks after delivery). Infants with chlamydia pneumonitis should be treated with oral erythromycin for 14 days.[1]
Historical Perspective
- In 1750, neonatal conjunctivitis (ophthalmia neonatorum) was first described by S.T. Quellmaz.[2]
- In 1881, Crédé introduced 2% silver nitrate for the first time as a prophylaxis treatment method for conjunctivitis in the newborns in Leipzig.[3]
Classification
According to the etiology ophthalmia neonatorum may be classified into::[2]
Pathophysiology
Pathogenesis
Neonatal conjunctivitis is occurring in a newborn during the first month of life, and often known as ophthalmia neonatorum. Neonatal conjunctivitis is mainly caused by sexually transmitted diseases agents such as Chlamydia trachomatis, Neisseria gonorrhoeae, and herpes simplex virus (HSV). Chlamydia trachomatis is the most common cause of ophthalmia neonatorum in the developed countries because of higher prevalence of chlamydia as a sexually transmitted disease.
The recognized routes of transmission of the organisms to the newborns include:[4]
- Infected birth canal during vaginal birth
- Transmembrane transmission of the infection
- Transplacental transmission of the infection
Additionally, silver nitrate drops (ocular prophylaxis) can cause ocular irritation and result in chemical conjunctivitis in newborn.[2]
Gross Pathology
On gross pathology, the following are characteristic findings of conjunctivitis:[5]
- Conjunctival injection
- Mucopurulent discharge or non-purulent discharge
- Pseudomembrane formation
- Chemosis
- Eyelid edema
- Conjunctival hemorrhage (specific for Acute hemorrhagic conjunctivitis)
Microscopic histopathological analysis
On microscopic histopathological analysis, the following are characteristic findings of infective conjunctivitis in neonate:[6]
- Mild spongiotic reaction pattern (low power view of the histology)
- Stromal infiltration by polymorphonuclear, leukocytes, plasma cells, mastocytes, and lymphocyte
- Numerous neutrophils (bacterial conjunctivitis)
Images
The following are gross and microscopic images associated with conjunctivitis:
-
Neonatal conjunctivitis<ref> Centers for Disease Control and Prevention's Public Health Image -
![Chlamydial conjunctivitis (Day 5-14)[7]](/images/3/39/Chlamydial_conjunctivitis.jpg)
Chlamydial conjunctivitis (Day 5-14)[7]
![Chlamydial conjunctivitis (Day 5-14)[7]](/index.php/File:Chlamydial_conjunctivitis.jpg)
Causes
- Septic
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Herpes simplex virus
- Pseudomonas aeruginosa (non–sexually transmitted bacteria)
- Staphylococcus aureus (non–sexually transmitted [bacteria)
- Aseptic
- Chemical (silver nitrate solution)
Differentiating ophthalmia neonatorum from Other Diseases
Neonatal conjunctivitis must be differentiated from:[2][8]
- Dacrocysitis
- Congenital glaucoma
- Nasolacrimal duct obstruction
- Preseptal/Orbital cellulitis
- Keratitis
==Epidemiology and Demographics
Prevalence and Incidence
- Worldwide, neonatal conjunctivitis or ophthalmia neonatorum still blinds approximately 10,000 babies annually.[9]
Gender=
- The incidence of neonatal conjunctivitis does not vary by gender.[10]
Developed Countries
Prevalence of neonatal conjunctivitis has decreased significantly in developed countries since the abandonment of silver nitrate as topical prophylaxis. Current prevalence of neonatal conjunctivitis in developed countries are 5 per 1000 live births.[11]
- In Belgium and Netherlands, the prevalence of neonatal conjunctivitis due to gonococcal infection was estimated 0.04 per 1000 live births.[2]
- In the United States, the prevalence of neonatal conjunctivitis due to gonococcal infection was estiamted 0.3 per 1000 live births.
- In the United States, the prevalence of neonatal conjunctivitis caused by chlamydial infection was estimated 5 to 60 cases per 1000 live births.
- In the United Kingdom, the prevalence of neonatal conjunctivitis caused by chlamydial infection was estimated 4 cases per 1000 live births.[12]
- In the United States, the incidence of bacterial conjunctivitis is 23,000 per 100,000 cases (in the 0-2 year age range), 28,000 per 100,000 cases (in the 3-9 year range), 13,000 per 100,000 cases (in the 10-19 year range) with the remaining 36,000 per 100,000 cases (in adults).[13]
Developing Countries
- In the Africa, the incidence of neonatal conjunctivitis is still high.[12]
References
- ↑ "Red Book - Report of the Committee on Infectious Diseases, 29th Edition. The American Academy of Pediatrics". Retrieved 2007-07-12.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Mallika P, Asok T, Faisal H, Aziz S, Tan A, Intan G (2008). "Neonatal conjunctivitis - a review". Malays Fam Physician. 3 (2): 77–81. PMC 4170304. PMID 25606121.
- ↑ "Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn". Am J Dis Child. 121 (1): 3–4. 1971. PMID 5543850.
- ↑ Treadwell P (1994). "Sexually transmitted diseases in neonates and infants". Semin Dermatol. 13 (4): 256–61. PMID 7848819.
- ↑ National Eye Institute (2015) [1] Accessed on June 24, 2016
- ↑ DermNet NZ (2015)[2] Accessed on June 26, 2016
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages
- ↑ 8.0 8.1 Woods, Charles R. "Gonococcal infections in neonates and young children." Seminars in pediatric infectious diseases. Vol. 16. No. 4. WB Saunders, 2005.
- ↑ Isenberg SJ, Apt L, Wood M (1996). "The influence of perinatal infective factors on ophthalmia neonatorum". J Pediatr Ophthalmol Strabismus. 33 (3): 185–8. PMID 8771523.
- ↑ Moore DL, MacDonald NE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee (2015). "Preventing ophthalmia neonatorum". Can J Infect Dis Med Microbiol. 26 (3): 122–5. PMC 4507834. PMID 26236350.
- ↑ Azari AA, Barney NP (2013). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–9. doi:10.1001/jama.2013.280318. PMC 4049531. PMID 24150468.
- ↑ 12.0 12.1 Schaller UC, Klauss V (2001). "Is Credé's prophylaxis for ophthalmia neonatorum still valid?". Bull World Health Organ. 79 (3): 262–3. PMC 2566367. PMID 11285676.
- ↑ Epling J (2010). "Bacterial conjunctivitis". BMJ Clin Evid. 2010. PMC 2907624. PMID 21718563.