What are the other Names for this Condition? (Also known as/Synonyms)

• Conjunctivitis of the Newborn
• Newborn Conjunctivitis
• Ophthalmia Neonatorum

What is Neonatal Conjunctivitis? (Definition/Background Information)

• Neonatal Conjunctivitis can be a severe disorder that occurs shortly after delivery in newborns (within a period of 30 days). It may be caused due to bacterial, viral microorganisms, or even on exposure to certain chemical substances (which is quite infrequent)
• If it is caused by the bacteria neisseria gonorrhoeae or chlamydia trachomatis that are responsible for sexually transmitted diseases (STD); then, urgent care with medications are essential to prevent permanent blindness and other potential complications from developing in the infant
• Conjunctivitis is inflammation of conjunctiva of the eye, which is the membrane covering the white region of the eye
• In this condition the white part of the eye turns red or pink, and hence it is known as Pink Eye. The infection may affect either one, or both the eyes, and is accompanied by inflammation, irritation, with watery discharge from the eyes. Under normal circumstances, Conjunctivitis does not affect vision

Neonatal Conjunctivitis is classified into the following types:

• Chemical Conjunctivitis
• Conjunctivitis due to Non-Sexually Transmitted Bacteria
• Gonococcal Conjunctivitis
• Chlamydial Conjunctivitis

Who gets Neonatal Conjunctivitis? (Age and Sex Distribution)

• Newborn babies, during the course of delivery can get Neonatal Conjunctivitis
• Both male and female genders are equally affected

What are the Risk Factors for Neonatal Conjunctivitis? (Predisposing Factors)

The risk factors for Neonatal Conjunctivitis include:

• Exposure to dangerous STD-causing pathogens at the time of delivery, which are present in the infected mother’s vagina or genital tract. These include neisseria and chlamydia (both bacteria), and the herpes virus. The newborns are at a high risk during the time of their birth and may acquire the infection from their mother
• Exposure to other bacteria or virus at the time of delivery
• An obstructed tear duct
• Administering eye drops containing silver nitrate. This was an earlier practice and is now almost eliminated in US & European countries. This causes Chemical Conjunctivitis
• Neglecting to administer anti-microbial eye drops (or use of improper, inadequate eye drops by the healthcare provider), in the period immediately following birth of the child
• Premature delivery (preterm)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Neonatal Conjunctivitis? (Etiology)

• Neonatal Conjunctivitis is caused by a variety of bacteria and some of these commonly include: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus viridans, and Hemophilus influenzae
• Other bacteria that cause the condition infrequently are: Enterobacter, Escherichia coli, Klebsiella pneumoniae, Proteus, and Serratia marcescens
• Chlamydia trachomatis and neisseria gonorrhoeae are dangerous bacteria that cause acute strains of Conjunctivitis in the newborn. Conjunctivitis could be one of the many symptoms of other underlying diseases/disorders
• The herpes simplex virus can cause a severe form of Conjunctivitis, known as neonatal herpes simplex virus Keratoconjunctivitis. However, this is a very rare type of disorder
• Chemical agents such as silver nitrate, once used to be a component of antibiotic eye applications, and were previously used to treat bacterial forms of Neonatal Conjunctivitis. This led to the development of the non-infectious chemical Conjunctivitis that lasts less than a week. Hence, it is being increasingly replaced by better alternatives (like erythromycin)
• A partially or completely blocked tear duct resulting from underdevelopment of the fetus (or due to other anomalies), may also cause conjunctiva problems
• Neonatal Conjunctivitis is contagious and the infectious phase may last for 10-14 days, until the eye returns to normal color

What are the Signs and Symptoms of Neonatal Conjunctivitis?

Common signs & symptoms of Neonatal Conjunctivitis are:

• Tenderness, inflammation, and redness of the eye(s); this may begin in one eye and slowly progress to the other
• Discharge of thick pus-like fluid from the eyes with formation of crusts; or watery drainage from the eyes
• The onset of symptoms for bacteria-caused Neonatal Conjunctivitis may take place anywhere within 5 days to 2 weeks; chemical irritant caused disorder may appear from day one, after contact with the chemical irritant

How is Neonatal Conjunctivitis Diagnosed?

Neonatal Conjunctivitis is diagnosed using the following tools:

• The ophthalmologist or physician performs an eye examination, evaluates the child’s and mother’s medical history, and the time period for onset of symptoms in the newborn child is noted (this factor could often be conclusive)
• Slit lamp exam (if necessary), for a detailed study of the eye
• Examination of conjunctival scrapings
• Blood, chocolate agar, tissue culture on conjunctival swabs
• Differential diagnosis of other types of Conjunctivitis should be considered, in order to eliminate other eye conditions
• Low birth weight and a preterm delivery, accompanied by signs of Conjunctivitis, may indicate infection by certain specific bacteria types

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Neonatal Conjunctivitis?

Complications may arise if the cornea is involved, or if there is a late recognition of the condition, leading to a delayed treatment. It is also dependent upon the type of bacteria or virus causing the infection, and the presence of secondary conditions. The complications could include:

• Corneal ulcer, scar, and perforation
• Bonding of eyelids to the eyeball, which may be partial or total
• Permanent eye damage, loss of vision in newborns
• Higher risk for other complications like central nervous system problems, pneumonia, septicemia
• Inflamed intraocular cavities
• Chronic recurrence of the condition

How is Neonatal Conjunctivitis Treated?

Early diagnosis and speedy treatment is important to prevent permanent complications from Neonatal Conjunctivitis. The underlying health disorders (if any) would also require to be treated. Some management measures include:

• Chemical Conjunctivitis resolves spontaneously within a few days (2-4 days), and no treatment may be required
• An obstruction in the tear duct may clear on its own, with therapeutic treatment (warm compress); otherwise surgical intervention may be required
• Conjunctivitis in Newborn from non-STD causing bacteria, resolves spontaneously within a few weeks. It also responds well to supportive treatment with antimicrobial drugs
• Use of lubricating eye drops may soothe the eyes, and helps remove crust formation
• Application of warm compress can help reduce discomfort
• Topical antibacterial ointments are generally prescribed for eye application. Systemic (whole body) antibiotics are vital in case the disorder is severe
• Antiviral medications are prescribed for herpes-associated Conjunctivitis
• In case of severe (and maybe chronic) infection leading to loss of vision; a corneal transplant may be necessary to restore vision
• Management of underlying health conditions is mandatory; and these could be STDs, sinusitis, and immune disorders
• Follow-up care is regularly required; more so if the condition aggravates
• Both the parents are also treated for STDs (if necessary, after evaluation of parents by a medical professional)

How can Neonatal Conjunctivitis be Prevented?

• To avoid Neonatal Conjunctivitis caused by microorganisms; a newborn child should be treated with erythromycin antibiotic eye ointment, shortly after birth
• The condition is highly infectious, if caused by bacteria or a virus. Hence, adequate precaution must be observed by the healthcare providers to prevent it from spreading
• Control spread of the condition by washing hands regularly, maintaining hygiene and cleanliness. This instruction is mainly directed towards the medical staff and mother of the child
• The onus is on all sexually mature individuals to ensure that they are generally well-informed of the sexually transmitted diseases (either by their healthcare providers, or public health authorities); and are aware of the preventive measures and precautions, more so if you are planning for a child
• In case you are aware of any STDs that are untreated, do inform your healthcare provider about the condition. This must be done as early as possible, particularly if you are pregnant
• In case the mother is diagnosed with STD; then a C-section delivery may be an option to prevent infection of the baby, which might otherwise occur from a natural birth

What is the Prognosis of Neonatal Conjunctivitis? (Outcomes/Resolutions)

• Most cases of Neonatal Conjunctivitis are self-limiting and have an excellent outcome, when treated early with topical antibiotics (antiviral & antibacterial applications) and on providing the necessary supportive management
• Acute Conjunctivitis triggered by herpes virus, gonococci & chlamydia bacteria have a potential to cause blindness and even life-threatening illnesses; if the underlying conditions are not quickly diagnosed and suitably managed
• Bacterial Conjunctivitis (caused by chlamydia, neisseria, staphylococcus) is a chronic infection and can recur periodically, if conditions are conducive for their recurrence

Additional and Relevant Useful Information for Neonatal Conjunctivitis:

• Neonatal Conjunctivitis caused by neisseria gonorrhoeae is termed as Gonococcal Conjunctivitis
• Neonatal Conjunctivitis caused by chlamydia trachomatis is termed as Inclusion (Chlamydial) Conjunctivitis
• Neonatal Conjunctivitis caused by herpes simplex virus is termed as Neonatal Keratoconjunctivitis