====== Neonatal Conjunctivitis ======

=====Signs/Symptoms=====
  * Gonococcal conjunctivitis- hyperacute onset (first 3 days up to 3 weeks of life) with copious, purulent conjunctival discharge
    * marked eyelid edema
    * chemosis 
    * Corneal involvement in 33% with corneal ulceration and possible perforation 
  * Chlamydial conjunctivitis- subacute onset (5 days to several weeks postpartum) with follicles on everted lower eyelid
    * blood-stained discharge in 33%
    * eyelid edema 
    * concurrent lung, nasopharynx, genital infection >50%
    * genital tract involvement is often present but may be asymptomatic 

===== Causes =====
  * Bacteria (36%)
    * Staphylococcus aureus 16%
    * Moxarella catarrhalis 9%
    * Streptococcus pneumoniae 3%
    * Pseudomonus aeruginosa- rare
    * Nisseria gonorrhoeae (0.4 per 100,000) 
  * Chlamydia trachomatis (<40%)
  * Viral (5%)
    * Rhinovirus 2.4%
    * Adenovirus 1.8%
    * Bocavirus 0.6%
    * Herpes simplex, rare
 =====Diagnosis=====
  * Suspect chlamydial ophthalmia 
    * obtain specimin from everted eyelid using Dacron-tipped swab or other specific swab
    * specimin must contain conjunctival cells  
    * Direct fluorescent antibody (DFA) is the only FDA-cleared non-culture test. 
    * Nucleic acid amplification test (PCR) may be used by CLIA approved labs 
    * Culture 
  * Suspect gonococcal ophthalmia 
    * Gram stain of conjunctival exudate looking for gram-negative intracellular diplococci 
    * Culture 
  * Dual testing for both of the above is recommended 

=====Treatment=====
  * Chlamydial ophthalmia neonatorum
    * erythromycin base or ethyl succinate 50 mg/kg/day divided QID x 14 days
    * in infants <6 weeks, watch for infantile hypertropic pyloric stenosis as a side effect 
  * Gonococcal ophthalmia neonatorum
    * ceftriaxone 25-50 mg/kg IV or IM x 1 dose (not to exceed 250 mg)
      * consider substitute in neonates with hyuperbilirubinemia 
      * do not give if receiving IV calcium
    * substitute: cefotaxime 100 mg/kg IV or IM x 1 dose 
  * Coinfection with the above two is common so combined treatment should be considered 
  * Other bacteria: consider moxifloxicin TID or QID x 10 days guided by culture with close follow-up
  * Viral- consider [[acyclovir|antiviral treatment]] for suspected HSV infection.