NEONATAL CONJUNCTIVITIS

Neonatal Conjunctivitis

Neonatal Conjunctivitis

Introduction

Neonatal conjunctivitis, often known by its Latin name of Ophthalmia neonatorum, is a conjunctivitis of the eyes of the new born caused by bacterial infection. Usually the infection is derived from the mother's genital tract at birth, in which case the causative organism is either the gonococcus (causative agent of gonorrhoea) or the genital serovars D to K of C. trachomatis. The observation of chlamydial neonatal conjuctivitis which developed three days after a child was born by Caesarian section with intact amniotic membranes suggests the possibility also of a rare transplacental or transmembrane route of infection (Shariat et al., 1992).

Numerous other bacteria may also cause conjunctivitis in the newborn, including commensal Neisseria, pneumococci, Klebsiella pneumoniae and Streptococcus mitis. These latter organisms are probably acquired after birth, as the mode of delivery has little influence  (Krohn et al., 1993). This article is concerned solely  with sexually acquired neonatal chlamydial conjunctivitis.

In the developed world, Chlamydia trachomatis is a much commoner cause of sexually acquired neonatal conjunctivitis than the gonococcus, except in certain focal inner city areas. Approximately a third  to a half of infants born through a chlamydial infected birth canal will develop neonatal conjunctivitis, the latter figure, from China, probably reflecting the sensitivity of PCR-based methods (Schachter et al., 1986; Shen et al., 1995). In China, the rate of chlamydial infection of the cervix in pregnant women in one locality was found to be 4.92% while the rate of chlamydial infection of the palpebral conjunctiva in the newborn was 8.57% by direct immuno-fluorescence (Zhang et al., 1994). These data suggest that chlamydial neonatal conjunctivitis and pneumonia are probably a significant, but little diagnosed problem in the developing world.

Typically, neonatal chlamydial conjunctivitis has an incubation period of 10 - 14 days compared with the much shorter 2 - 3 days incubation for gonococcal ophthalmia. The orbit of the eye is usually quite swollen, and there is a mucoid discharge which is less frankly purulent than that usually seen with overt gonococcal ophthalmia. The infection is particularly common in pre-term babies, who are often born to women at particular risk of C. trachomatis infection (Francois et al., 1989).

It does NOT respond well to treatment with chloramphenicol eye ointment. After some two weeks, a conjunctival swab taken from the eye, smeared onto a microscope slide and stained with chlamydia trachomatis specific fluorescent monoclonal antibody often shows the presence of an impressively large number of punctate, fluorescing chlamydial elementary bodies, looking like the "star-spangled sky at night". In neonatal conjunctivitis, the nasopharynx is also commonly infected with C. trachomatis (Beem & Saxon, 1977), presumably via drainage from the oto-lachrymal duct, so it is important to treat the infants with systemic rather than topical antibiotic. As the causative organism is a sexually transmitted infection, it is vital to ensure that the mother and her sexual partner(s) are also treated.

If left untreated, approximately 10 - 20% of infants will develop neonatal pneumonia (Beem & Saxon, 1977), a condition sometimes ...