Sandra Cerar
Klinični oddelek za neonatologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija in Katedra za pediatrijo, Medicinska fakulteta, Univerza v Ljubljani, Ljubljana, Slovenija

Tina Plankar Srovin
Klinika za infekcijske bolezni in vročinska stanja, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija in Katedra za infekcijske bolezni in epidemiologijo, Medicinska fakulteta, Univerza v Ljubljani, Ljubljana, Slovenija

Manca Tekavčič Pompe
Očesna klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija in Katedra za oftalmologijo, Medicinska fakulteta, Univerza v Ljubljani, Ljubljana, Slovenija

Gregor Nosan
Klinični oddelek za neonatologijo, Pediatrična klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija in Katedra za pediatrijo, Medicinska fakulteta, Univerza v Ljubljani, Ljubljana, Slovenija

Abstract

Neonatal ophthalmia (NO) is an acute inflammation of the conjunctiva in the first month of life, most commonly caused by infection with maternal vaginal bacteria. Due to the discontinuation of universal prophylaxis for gonococcal NO, changing prevalence of sexually transmitted infections (STI) in pregnant women, and a recent case of neonatal gonococcal NO, we present updated recommendations for its treatment and prevention. Treatment depends on the timing of symptom onset. Profuse purulent discharge with eyelid swelling within the first five days suggests gonococcal NO, which requires immediate parenteral antibiotic therapy. After the fifth day, chlamydial NO is more likely and is treated systemically with azithromycin, while other bacterial infections are treated topically with tobramycin. Prevention of NO is based on maternal STI risk assessment, microbiological findings, and treatment. If vaginal swabs for Neisseria gonorrhoeae and Chlamydia trachomatis are negative or the maternal infection was adequately treated, no intervention is required in the newborn. In cases of inadequately treated maternal gonococcal infection, the newborn is treated regardless of signs of NO. In inadequately treated maternal chlamydial infection, treatment is indicated only if signs of NO are present. If microbiological testing was not performed in a mother with the STI risk factors, the newborn requires NO prophylaxis.

Key words: newborn, neonatal ophtalmia, management, treatment, prophylaxis