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Newborn Conjunctivitis(Ophthalmia Neonatorum; Neonatal Conjunctivitis)
Definition

Newborn conjunctivitis is redness and swelling of the surface or covering of the eye. It generally occurs in the first month of life.

Conjunctivitis

Inflamed conjunctiva

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Causes

The cause of the conjunctivitis may be an irritation in the eye or a blocked tear duct. In some cases, the irritation may be from the antibiotic given after delivery.

Bacteria or viruses from the mother's birth canal can also cause an infection in the eye. These infections can include:

  • Sexually transmitted diseases (STDs)—The most common bacteria passed to infants during delivery are due to STDs from the mother’s birth canal. If untreated, many of these infections can cause serious damage to the infant’s eye. STDs that can cause eye damage include:
  • Skin bacteria
  • Bacteria from the mother’s gastrointestinal tract
Risk Factors

The biggest risk factor for developing newborn conjunctivitis is a maternal infection or sexually transmitted disease (STD) at the time of delivery. The mother may not have any symptoms during delivery, but may still be able to transmit the infection. If you are pregnant, it is important to discuss any STDs that you have or have had in the past. You and your doctor can develop a plan to protect your baby from infections during delivery.

Symptoms

The most common symptoms are redness and swelling of the conjunctiva in the newborn. Newborn conjunctivitis may also cause:

  • Drainage and discharge from the eye—it may be watery or thick and pus-like
  • Swollen eyelids
Diagnosis

If your baby’s doctor suspects newborn conjunctivitis, an eye examination will be done. The doctor will look at your baby’s eyes to check for anything that may be irritating the eye and to see if any damage has occurred. The doctor may also want to take a sample of any discharge to determine what type of bacteria or virus is causing the infection.

Treatment

The treatment of newborn conjunctivitis depends on the cause:

Blocked Tear Duct

In cases of newborn conjunctivitis that are due to a blocked tear duct, the doctor may advise warm compresses and gentle massage to the area to help unclog the duct.

Irritation

Newborn conjunctivitis due to irritation usually improves on its own in a few days. In some cases, the irritation may be from the antibiotic given after delivery. Silver nitrate, which was often used in the past to prevent eye infection, can cause irritation in the baby’s eye. Many hospitals now use other types of antibiotics to avoid this irritation.

Bacteria

The eye will be washed to remove discharge. Infants with an eye infection due to bacteria, such as chlamydia or gonorrhea, are given antibiotics. Infants with gonococcal conjunctivitis will also be treated for chlamydia.

Bacterial cases of newborn conjunctivitis are rare because of hospital infection prevention measures. When they do occur, they are usually identified quickly. Antibiotic treatment is effective and the infection resolves quickly.

Herpes

Infants with newborn conjunctivitis due to the herpes virus are given antiviral medication by IV and antiviral eye drops or ointment.

Prevention

Since the potential for serious eye damage to the infant is so great, it is standard treatment in US hospitals to give infants antibiotic eye drops or ointment right after delivery. This helps prevent the development of an eye infection even if the mother shows no symptoms of infection. Prevention methods for newborn conjunctivitis include:

  • Antibiotic eye ointment given to the infant after birth
  • Treating the mother for any sexually transmitted diseases (STDs) prior to labor and delivery
  • A cesarean section for mothers with active genital herpes lesions

An open, honest relationship with your doctor is important during your pregnancy. Disclosure of your full medical history can help protect your baby from infection.

RESOURCES:

American Association for Pediatric Ophthalmology and Strabismus
http://www.aapos.org

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES:

About Kids Health—The Hospital for Sick Children
http://www.aboutkidshealth.ca

Caring for Kids—Canadian Paediatric Society
http://www.caringforkids.cps.ca

References:

Akera C, Ro S. Medical concerns in the neonatal period. Clinics in Family Practice. 2003;5(2):265-292.

Conjunctivitis (pink eye) in newborns. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/conjunctivitis/newborns.html. Updated June 30, 2016. Accessed August 24, 2016.

Neonatal conjunctivitis. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/pediatrics/infections-in-neonates/neonatal-conjunctivitis. Updated October 2015. Accessed August 24, 2016.

Neonatal conjunctivitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114334/Neonatal-conjunctivitis. Updated December 22, 2015. Accessed September 26, 2016.



Last reviewed November 2015 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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