What Is Ophthalmia Neonatorum?

The main reasons are improper operation, chemical damage, bacterial (including chlamydia) infection, and viral infection. Chemical conjunctivitis is usually secondary to the stimulation of silver nitrate to prevent eye diseases; chlamydia ophthalmitis is caused by the delivery process. The obtained Chlamydia trachomatis caused .2% to 4% of live birth infants, accounting for 30% to 50% of neonatal conjunctivitis at <4 weeks. The prevalence of chlamydia infection in mothers was 2% to 20%. Conjunctivitis occurs in about 30% to 40%, and pneumonia occurs in 10% to 20%; other bacterial infections, including Streptococcus pneumoniae and Haemophilus atypicalus, account for 15% of neonatal conjunctivitis. In the United States, The incidence of coccoccal neonatal conjunctivitis (newborn conjunctivitis due to gonococcus) is 2/10000 to 3/10000 of live births. The isolated bacteria include gold in addition to Haemophilus influenzae and gonococcus. Staphylococcus aureus often represents colonization rather than infection; the viruses that cause neonatal conjunctivitis are mainly herpes simplex virus type I and type II (herpetic keratitis).

Neonatal ophthalmitis

Knots and keratitis occur within 28 days of birth. The scientific name is neonatal ophthalmitis. According to the pathogenic culprit, it is divided into two categories: gonococcal ophthalmia and non-gonococcal ophthalmia. Ophthalmitis of the newborn is mostly caused by vaginal delivery, and it can also occur in the uterus or after birth. The pathogens they infect are constantly changing with the development of the times, from streptococci to staphylococci to gonococci. Induced purulent discharge from the eyes of the newborn.

Etiology and epidemiology of neonatal ophthalmitis

Neonatal ocular inflammation signs and symptoms

Conjunctivitis caused by different causes overlaps in onset and clinical manifestations, and it is difficult to distinguish clinically.

Chemical conjunctivitis secondary to silver nitrate eye drops often appears 6 to 8 hours after use and disappears within 24 to 48 hours.

Chlamydia ophthalmitis usually occurs within 5 to 14 days after birth. Mild conjunctivitis has only a small amount of viscous secretions. Severe conjunctivitis has eyelid edema, a large amount of purulent secretions and false membranes are formed, and no follicles are present. One thing is different from older children and adult patients.

Gonorrhea ophthalmia occurs in acute purulent conjunctivitis within 2 to 5 days after birth. If premature rupture of the amniotic membrane, it may occur earlier. Children have severe eyelid edema with bulbar conjunctival edema, and there is a large amount of pus on its own when separating the eyelids. Corneal ulcers can occur if left untreated.

The onset of conjunctivitis caused by other bacteria ranges from 4 days to 3 weeks after birth.

Herpetic keratoconjunctivitis can be an independent infection or it can occur simultaneously with systemic or central nervous system infections. It can be misdiagnosed as bacterial or chemical conjunctivitis, but the presence of dendritic keratitis has pathological characteristics.

Diagnosis of neonatal ophthalmia

The best diagnosis method for chlamydia ophthalmopathy is to isolate Chlamydia trachomatis in tissue culture. Use cotton swabs or Dacron swabs to rub open lower eyelid mucosa to obtain secretions for cultivation. Direct monoclonal antibody test from purulent secretions smears Detection of Chlamydia in the medium, and the enzyme-linked immunosorbent assay (ELISA) is sensitive and specific for the detection of Chlamydia in conjunctival culture.

Gonorrhea ophthalmia must exclude gonococcal infections. The first step of diagnosis is the culture of conjunctival secretions and Gram staining. Cultures need to be placed in a suitable medium (such as Thayer-Martin) to isolate gonococci. Intracellular leather under the microscope Negative of Langerhans, coffee bean-shaped Diplococcus suggest gonococcal infection. Gram staining can also help to identify other bacteria. In chlamydia infection, the conjunctival secretion smear should show a significant monocyte response without bacteria .

Herpetic keratoconjunctivitis can be diagnosed by virus isolation, immunofluorescent HSV- or HSV- antigen determination of conjunctival secretions, or HSV particles by electron microscope. Specific diagnosis is important because the disease can spread to Central nervous system and other organs.

Newborn ophthalmia prevention

The Centers for Disease Control and Prevention (CDC) recommends that newborns routinely use 1% silver nitrate, erythromycin or tetracycline eye drops or drops in each eye after birth to prevent neonatal gonococcal conjunctivitis. However these preparations No one can prevent chlamydia ophthalmitis. Newborns with untreated mothers who have gonorrhea have infections in other parts of the body in addition to the eyes; term infants should receive intramuscular or intravenous injections of ceftriaxone 50mg / kg, with a maximum dose of 125mg Due to the high proportion of penicillin-producing Neisseria gonorrhoeae found in many places, penicillin is no longer the first line drug for the treatment of gonococcal infections.

Neonatal ophthalmitis treatment

At least 1/2 of newborns infected with chlamydia ophthalmitis also have nasopharyngeal infections, and some newborns develop chlamydia pneumonia, so systemic treatment is the best choice. Ethyl succinate 50 mg / (kg.d) is recommended ), Divided into once every 6 hours or every 8 hours for a total of 2 weeks of treatment.

Children with gonococcal eye disease should be hospitalized and given an intramuscular injection of 25-50 mg / kg ceftriazine; the maximum single dose is 125 mg (100 mg / kg can also be used). Repeated flushing of the eyes with physiological saline can prevent the adhesion of secretions. Separately The use of a surface antimicrobial ointment is not enough. If antibiotics have been used throughout the body, topical medications can be discontinued.

Conjunctivitis caused by other bacteria is usually effective on surface eye ointments containing polymyxin plus bacitracin, erythromycin, and tetracycline.

The treatment of herpetic keratoconjunctivitis is systemic acyclovir (30 mg / kg daily 3 times in 14 to 21 days; premature infants 20 mg / kg daily 2 times) and topical three Fluorothymidine eye drops or ointment or 3% arabinose ointment, once every 2 to 3 hours when the baby wakes up, and combined with iodoside ointment while sleeping. It is necessary for neonatal systemic treatment because Infections can spread to the central nervous system and other organs.

Because ointments contain corticosteroids, serious eye infections caused by Chlamydia trachomatis and herpes simplex virus can worsen, and this ointment should be avoided.