REVIEW ARTICLE

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NEONATAL CONJUNCTIVITIS – A REVIEW

Ophthalmia neonatorum due to C. trachomatis

WHO and American Academy of Pediatrics recommendation include oral erythromycin syrup, 50 mg/kg/day, in 4 divided doses for 14 days.40 Topical erythromycin or tetracycline can be used as an adjunct therapy. The advantages of oral erythromycin include eradication of the nasopharyngeal carriers, treatment of associated pneumonitis and also being more effective than topical in preventing relapse of conjunctivitis 2 Infected partners should receive oral doxycycline 100 mg twice daily for 7 days or azithromycin 1 g orally as a single dose.39

Ophthalmia neonatorum due to N. gonorrhoea

Treatment of gonococcal conjunctivitis consists of Intravenous Penicillin G 100,000 Units /kg/day for 1 week. N. gonorrhoea isolates are resistant to penicillin in many urban areas in USA. Across Africa, rates of pencillinase-producing N. gonorrhoea range from 18 to 57% and many other parts of world (50% to 60%).31,15 Hence a third-generation cephalosporin drug should be used for 7 days in areas where pencillinase producing strains are endemic. A single dose of ceftriaxone 50 mg/kg as s single dose (maximum 125 mg) is highly effective and recommended by WHO guidelines.41,42 Alternative medications include spectinomycin 25 mg/kg (maximum 75 mg) as a single IM dose and kanamycin 25 mg/kg (maximum 75 mg).43 Infected mother should also be treated with single dose of ceftriaxone (25-50 mg/kg). The infant’s eye should be frequently irrigated with normal saline to eliminate the discharge.

Ophthalmia neonatorum due to Herpes simplex virus

Neonates suspected of conjunctivitis due to herpes simplex should be treated with low dose systemic acyclovir (30mg/kg/day IV divided tid) or vidarabine (30 mg /kg/day in divided doses IV) for at least 2 weeks44 to prevent dissemination of infection. Topical treatment may be with vidarabine ointment or trifluridine eye drops.

RECOMMENDATIONS AND CONCLUSION

Awareness of the perinatal implications and routine screening for Chlamydia in pregnant women will provide safer health care for the mother and her baby. Treatment of any maternal infection prior to delivery can help reduce the burden of this disease, and also help to decrease the incidence of childhood blindness not only in developing nations but also in developed countries.

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