Conjunctivitis of the newborn

P39.1

DESCRIPTION

Inflammation of the conjunctivae in the neonatal period, presenting with a picture that may range from mildly sticky eyes to an abundant purulent discharge and eyelid oedema.
Common infectious agents include N. gonorrhoeae, S. aureus, and Chlamydia.

Generally, conjunctivitis of the newborn is either mild (small amount of sticky exudates) or severe (profuse pus and swollen eyelids).

The latter is often N. gonorrhoeae and threatens damage to the cornea, while the former is often S. aureus or undefined.

CAUTION

Treat conjunctivitis with abundant pus immediately to prevent damage to the cornea that may lead to blindness. This is often caused by gonorrhoeae. Treat parents of a neonate with purulent discharge, appropriately.

GENERAL MEASURES

  • Cleanse or wipe eyes of all newborn babies with a clean cloth, cotton wool or swab, taking care not to touch or injure the eye.

MEDICINE TREATMENT

Prevention

Routine administration for every newborn baby:

  • Chloramphenicol 1%, ophthalmic ointment, applied as soon as possible after birth.

Treatment

Sticky eye(s) without purulent discharge:

  • Chloramphenicol 1%, ophthalmic ointment, applied 6 hourly for 7 days.

Purulent discharge:

i.e. mild discharge without swollen eyelids and no corneal haziness:

  • Sodium chloride 0.9%, eye washes, immediately then 2–3 hourly, until discharge clears.

AND

  • Ceftriaxone, IM, 50mg/kg immediately as a single dose .
Weight
kg
Dose
mg
Use one of the following
injections mixed with water
for injection (WFI):
 		Use one of the following
injections mixed with water
for injection (WFI):
 		Age
Months/years
250 mg/2 mL
(250 mg diluted
in 2 mL WFI)
 500 mg/2 mL
(500 mg diluted
in 2 mL WFI)
˃2–2.5 kg 100 mg 0.8 mL 0.4 mL >34–36 weeks
˃2.5–3.5 kg 150 mg 1.2 mL 0.6 mL >36 weeks–1 month
˃3.5–5.5 kg 200 mg 1.6 mL 0.8 mL ˃1–3 months

Review daily.

Abundant purulent discharge and/or swollen eyelids and/or corneal haziness:

  • Sodium chloride 0.9%, eye washes, immediately then hourly until referral.

AND

  • Ceftriaxone, IM, 50mg/kg immediately as a single dose, and refer.
Weight
kg
Dose
mg
Use one of the following
injections mixed with water
for injection (WFI):
 		Use one of the following
injections mixed with water
for injection (WFI):
 		Age
Months/years
250 mg/2 mL
(250 mg diluted
in 2 mL WFI)
 500 mg/2 mL
(500 mg diluted
in 2 mL WFI)
˃2–2.5 kg 100 mg 0.8 mL 0.4 mL >34–36 weeks
˃2.5–3.5 kg 150 mg 1.2 mL 0.6 mL >36 weeks–1 month
˃3.5–5.5 kg 200 mg 1.6 mL 0.8 mL ˃1–3 months

CAUTION: USE OF CEFTRIAXONE IN NEONATES AND CHILDREN

  • If SUSPECTING SERIOUS BACTERIAL INFECTION in neonate, give ceftriaxone, even if jaundiced.
  • Avoid giving calcium-containing IV fluids (e.g. Ringer Lactate) together with ceftriaxone:
    • If ≤ 28 days old, avoid calcium-containing IV fluids for 48 hours after ceftriaxone administered.
    • If >28 days old, ceftriaxone and calcium-containing IV fluids may be given sequentially provided the giving set is flushed thoroughly with sodium chloride 0.9% before and after.
    • Preferably administer IV fluids without calcium contents
  • Always include dose and route of administration of ceftriaxone in the referral letter.

Treat both parents of newborns who develop purulent conjunctivitis after 24 hours of birth for N.gonorrhoeae and Chlamydia.

Parents:

  • Ceftriaxone, IM, 250 mg as a single dose.
    • For ceftriaxone IM injection: Dissolve ceftriaxone 250 mg in 0.9 mL lidocaine 1% without epinephrine (adrenaline).

AND

  • Azithromycin, oral, 1 g as a single dose.

REFERRAL

Urgent

  • All neonates with abundant purulent discharge and/ or swollen eyelids and/or corneal haziness.
  • Neonate unresponsive to treatment within 2 days.