Neonatal conjunctivitis


– Conjunctivitis due to Neisseria gonorrhoeae and/or Chlamydia trachomatis in neonates born to mothers with genital gonococcal and/or chlamydial infections at the time of delivery.
– Neonatal conjunctivitis is a medical emergency. Without prompt treatment, risk of corneal lesions and visual impairment.

Clinical features

– Unilateral or bilateral purulent conjunctivitis in the first 28 days of life.

Treatment

– Clean eyes with isotonic sterile solution (0.9% sodium chloride or Ringer lactate) 4 times daily to remove secretions.
– Antibiotic treatment:
• for all neonates with conjunctivitis in the first 28 days of life
• for all neonates born to mothers with a genital infection (purulent cervical discharge) at the time of delivery 


0 to 7 days

8 to 28 days

First line


ceftriaxone IM: 50 mg/kg single dose (max. 125 mg)


ceftriaxone IM: 50 mg/kg single dose (max. 125 mg)
+
azithromycin PO: 20 mg/kg once daily for 3 days

Alternatives

If ceftriaxone contra-indicated:
cefotaxime
IM: 100 mg/kg single dose

If azithromycin unavailable:
erythromycin PO: 12.5 mg/kg 4 times daily for 14 days

If symptoms persist 48 hours after parenteral treatment alone, administer azithromycin PO (or erythromycin PO as above).

Notes:
– When systemic treatment is not immediately available, clean both eyes and apply 1% tetracycline eye ointment every hour, until systemic treatment is available.
– In all cases, treat the genital infection of the mother and partner (see Genital infections, Chapter 9).
– Azithromycin and erythromycin are associated with an increased risk of pyloric stenosis in neonates. The risk is higher with erythromycin1,2,3. Adverse effects should be monitored.

Prevention

Apply as soon as possible and preferably within one hour after birth:
1% tetracycline eye ointment: application of 1 cm in each eye.



References

  1. Lund M et al. Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ. 2014; 348: g1908.
    https://www.bmj.com/content/348/bmj.g1908 [Accessed 16 April 2021]

  2. Murchison L et al. Post-natal erythromycin exposure and risk of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Pediatr Surg Int. 2016 Dec; 32(12): 1147-1152. 
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106491/ [Accessed 16 April 2021]

  3. Almaramhy HH et al. The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Ital J Pediatr. 2019 Feb 4; 45(1)20. 
    https://ijponline.biomedcentral.com/articles/10.1186/s13052-019-0613-2 [Accessed 16 April 2021]