The neonatal conjunctivitis is an aqueous or purulent eye discharge due to infection or chemical irritation. A prevention with antigonococcalem topical treatment at birth is routine. Diagnosis is confirmed clinically and by laboratory tests in general. It is treated pathogen-specific.
The neonatal conjunctivitis is an aqueous or purulent eye discharge due to infection or chemical irritation. A prevention with antigonococcalem topical treatment at birth is routine. Diagnosis is confirmed clinically and by laboratory tests in general. It is treated pathogen-specific. Etiology The main causes (in descending order) Bacterial infection Dry inflammatory viral infections (overview of conjunctivitis) infections are most often caused by the entry into the birth canal in infected mothers. Chlamydia infections (caused by Chlamydia trachomatis) is the most common bacterial cause; it is responsible for 40% of Konjunktivitisfälle in neonates <4 weeks. The prevalence of chlamydial infection in mothers is approximately 2-20%. 30-50% of infants born to acutely ill women get an infection and 25-50% of these develop conjunctivitis (and 5-20% develop pneumonia). Other bacteria, including Streptococcus pneumoniae and Haemophilus influenzae nichttypisiertem cause additional 30-50% of cases, while (due to Neisseria gonorrhoeae conjunctivitis) a gonococcal ophthalmia represents <1% of the cases. The chemical conjunctivitis is often the result of a prophylactic topical treatment. The most common virus is the herpes simplex virus (HSV) type 1 or 2 (Herpeskeratokonjunktivitis), but this virus causes <1% of cases. Symptoms and complaints Since symptoms and manifestation times are similar, the different types of neonatal conjunctivitis can be clinically difficult to differentiate. The conjunctiva are infected and aqueous or purulent discharge is present. The chemical conjunctivitis due to topical prophylaxis appears often within 6-8 hours after application and disappear spontaneously within 48-96 hours. The Chlamydienkonjunktivitis manifests itself usually 5-14 days after birth. The symptoms can range from a mild conjunctivitis with minimal mucopurulent secretion to a heavy lid edema with profuse secretion and pseudo membrane formation. Unlike older children and adults are not present lymphoid follicles in the conjunctiva. When it comes Gonokokkenkonjunktivitis 2-5 days after birth, or - if premature rupture of membranes - even earlier, to an acute purulent conjunctivitis. The eyelids are massively swollen, and as a result there will be a chemosis and massive purulent Sekretaufstau which may be under pressure. Untreated corneal ulcers and blindness can occur. Conjunctivitis caused by other bacteria have different manifestation points in time, which can range up to 3 weeks of four days. The herpetic keratoconjunctivitis occurs as an isolated infection or with disseminated or CNS infection. It can be confused with bacterial or chemical conjunctivitis; the occurrence of dendritic keratitis, however, is pathognomonic. Diagnostic inquiry of conjunctival material pathogens, including gonorrhea, chlamydia and sometimes herpes The Konjunktivalsekret is Gram-stained cultured for gonococcal on Thayer-Matin medium and direct immunofluorescence, ELISA or direct monoclonal antibody testing (samples must cells included) for Chlamydia examined. The conjunctival swabs are Giemsa-stained; if blue intracytoplasmic inclusions are found, the diagnosis can be confirmed Chlamydienkonjunktivitis. Nucleic acid amplification tests show over older methods equivalent or better sensitivity for the detection of Chlamydia in the conjunctival material. Viral cultures are created only if a viral infection is suspected because of skin lesions or maternal infection. Treatment Systemic, topical or combined antimicrobial therapy newborns with conjunctivitis and maternal gonococcal infection or with gram-negative intracellular diplococci in exudates of the conjunctiva should before confirmation by the tests with ceftriaxone or cefotaxime (see Table: Recommended doses of selected pareneraler antibiotics for newborns) are treated. When Chlamydienophthalmie systemic treatment is the treatment of choice because at least half of the newborns is also suffering from an infection of the nose and throat and can fall ill with chlamydial pneumonia. Erythromycin is recommended p.o. 12.5 mg / kg every 6 h for 2 weeks (see table: Recommended dosage of selected oral antibiotics for newborns *) The therapy is only effective in 80% of cases, so often a second treatment is necessary. Because treatment with erythromycin in newborns in the development of hypertrophic pyloric stenosis (HPS) is associated, all newborns treated with erythromycin should be monitored for symptoms and findings of HPS. A Informing parents about potential risks is necessary. Azithromycin 20 mg / kg p.o.1 times daily for 3 days may be effective, but is not recommended by the American Academy of Pediatrics. A newborn with a Gonokokkenkonjunktivitis is hospitalized and examined for systemic signs. It receives a single dose of ceftriaxone 25-50 mg / kg i.m. up to a maximum of 125 mg. Infants with hyperbilirubinemia or those who receive calcium-containing fluids should not receive ceftriaxone, and they should be a single dose of cefotaxime 100 mg / kg i.v. or i.m. are given. The eye is often washed out with saline so that it does not stick. Topical antimicrobial ointments alone are ineffective and are not necessary when systemic therapy is provided. All conjunctivitis caused by other bacteria are topically treated with ointments containing polymyxin bacitracin, erythromycin or tetracycline. The Herpeskeratokonjunktivitis should systemically 20 mg / kg acyclovir ointment with every 8 h for 14-21 days and topically with 1% trifluridine-containing eyedrops or, vidarabine 3% -containing ointment or a 0.1% -Ioddesoxyuridinhaltigen eye ointment every 2 -3 h, a maximum of 9 doses over 24 hours, are treated. Systemic therapy is important because a spread can occur in the CNS and other organs. Corticosteroid ointments should be avoided as they can aggravate extremely eye infections due to C. trachomatis and herpes simplex. Prevention The routine use of 1% -Silbernitrat-, 0.5% -Erythromycin- or 1% tetracycline-containing eye drops or eye ointment in each eye can effectively prevent a gonococcal infection after birth. but none of these drugs can prevent chlamydia infection; against chlamydial and gonococcal 2.5% -Polyvidon-containing eye drops can be used in the US but not admitted. Silver nitrate and tetracycline eye ointment in the US are also no longer available. Newborns of mothers with untreated gonococcal infection should a single dose of ceftriaxone 25-50 mg / kg i.m. or i.v., up to 125 mg (ceftriaxone should not be used to receive in neonates with hyperbilirubinemia or those calcium-containing liquids) obtained. Both mother and newborn should be examined for a chlamydial infection, HIV and syphilis. Summary C. trachomatis, S. pneumoniae and non-typable H. influenzae cause most bacterial conjunctivitis; N. gonorrhoeae is a rare cause. The conjunctiva are infected and rather watery or purulent discharge from. It makes sense to studies of conjunctival material to pathogens (including gonorrhea and chlamydia) with culture and sometimes nucleic acid amplification tests. Recommended antibiotics are against the pathogen; Newborns with gonococcal infection should be hospitalized. Prescribe a systemic therapy for chlamydial ophthalmia. A Chemical composition conjunctivitis can be caused by antimicrobial drops for the prevention of bacterial conjunctivitis at birth.