词条 | Neonatal conjunctivitis |
释义 |
| name = Neonatal conjunctivitis | synonyms = | image = Gonococcal ophthalmia neonatorum.jpg | caption = A newborn with gonococcal ophthalmia neonatorum | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }}Neonatal conjunctivitis, also known as ophthalmia neonatorum, is a form of conjunctivitis and a type of neonatal infection contracted by newborns during delivery. The baby's eyes are contaminated during passage through the birth canal from a mother infected with either Neisseria gonorrhoeae or Chlamydia trachomatis.[1] Antibiotic ointment is typically applied to the newborn's eyes within 1 hour of birth as prevention gonococcal ophthalmia.[2] This practice is recommended for all newborns and most hospitals in the United States are required by state law to apply eye drops or ointment soon after birth to prevent the disease.[3][4] If left untreated, it can cause blindness. Signs and symptomsNeonatal conjunctivitis by definition presents during the first month of life. It may be infectious or noninfectious.[5] In infectious conjunctivitis, the organism is transmitted from the genital tract of an infected mother during birth or by infected hands.
Time of onsetChemical causes: Right after delivery Neisseria gonorrhoeae: Delivery of the baby until 5 days after birth (early onset) Chlamydia trachomatis: 5 days after birth to 2 weeks (late onset — C. trachomatis has a longer incubation period)[6]ComplicationsUntreated cases may develop corneal ulceration, which may perforate, resulting in corneal opacification and staphyloma formation. CauseNoninfectiousChemical irritants such as silver nitrate can cause chemical conjunctivitis, usually lasting 2–4 days. Thus, prophylaxis with a 1% silver nitrate solution is no longer in common use.[7] In most countries, neomycin and chloramphenicol eye drops are used, instead.{{Citation needed|date=January 2012}} However, newborns can suffer from neonatal conjunctivitis due to reactions with chemicals in these common eye drops.[8] Additionally, a blocked tear duct may be another noninfectious cause of neonatal conjunctivitis. InfectiousMany different bacteria and viruses can cause conjunctivitis in the neonate. The two most common causes are N. gonorrheae and Chlamydia acquired from the birth canal during delivery. Ophthalmia neonatorum due to gonococci (N. gonorrhoeae) typically manifests in the first 5 days after birth and is associated with marked bilateral purulent discharge and local inflammation. In contrast, conjunctivitis secondary to infection with C. trachomatis produces conjunctivitis 3 days to 2 weeks after delivery. The discharge is usually more watery in nature (mucopurulent) and less inflamed. Babies infected with chlamydia may develop pneumonitis (chest infection) at a later stage (range 2–19 weeks after delivery). Infants with chlamydia pneumonitis should be treated with oral erythromycin for 10–14 days.[9] Other agents causing ophthalmia neonatorum include herpes simplex virus (HSV 2), Staphylococcus aureus, Streptococcus haemolyticus, and Streptococcus pneumoniae. Diagnosis is performed after taking swab from the infected conjuctva. PreventionAntibiotic ointment is typically applied to the newborn's eyes within 1 hour of birth as prevention against gonococcal ophthalmia.[2] This may be erythromycin, tetracycline, or rarely silver nitrate.[2] Treatment{{More citations needed|section|date=January 2012}}Prophylaxis needs antenatal, natal, and postnatal care.
Systemic therapy: Newborns with gonococcal ophthalmia neonatorum should be treated for 7 days with ceftriaxone, cefotaxime, ciprofloxacin, or crystalline benzyl penicillin.
EpidemiologyThe disease incidence varies widely depending on the geographical location. The most extensive epidemiological survey on this subject has been carried out by Dharmasena et al.[14] who analysed the number of neonates who developed neonatal conjunctivitis in England from 2000 to 2011. In addition to the incidence of this sight-threatening infection, they also investigated the time trends of the disease. According to them, the incidence of neonatal conjunctivitis (ophthalmia neonatorum) in England was 257 (95% confidence interval: 245 to 269) per 100,000 in 2011. See also
References1. ^{{Cite journal|last=Tan|first=Aik-Kah|date=2019-01-09|title=Ophthalmia Neonatorum|journal=New England Journal of Medicine|volume=380|issue=2|pages=e2|language=en|doi=10.1056/NEJMicm1808613|pmid=30625059}} 2. ^1 2 {{cite journal|last1=Matejcek|first1=A|last2=Goldman|first2=RD|title=Treatment and prevention of ophthalmia neonatorum.|journal=Canadian Family Physician|date=November 2013|volume=59|issue=11|pages=1187–90|pmid=24235191|pmc=3828094}} 3. ^1 {{Cite web|url=https://www.cdc.gov/conjunctivitis/newborns.html|title=Conjunctivitis {{!}} Pink Eye {{!}} Newborns {{!}} CDC|website=www.cdc.gov|access-date=2016-11-11}} 4. ^{{cite journal |last1=Curry |first1=Susan J. |last2=Krist |first2=Alex H. |last3=Owens |first3=Douglas K. |last4=Barry |first4=Michael J. |last5=Caughey |first5=Aaron B. |last6=Davidson |first6=Karina W. |last7=Doubeni |first7=Chyke A. |last8=Epling |first8=John W. |last9=Kemper |first9=Alex R. |last10=Kubik |first10=Martha |last11=Landefeld |first11=C. Seth |last12=Mangione |first12=Carol M. |last13=Silverstein |first13=Michael |last14=Simon |first14=Melissa A. |last15=Tseng |first15=Chien-Wen |last16=Wong |first16=John B. |title=Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum |journal=JAMA |date=29 January 2019 |volume=321 |issue=4 |pages=394–398 |doi=10.1001/jama.2018.21367|pmid=30694327 }} 5. ^{{cite web |url=http://emedicine.medscape.com/article/1192190-overview |title=Conjunctivitis, Neonatal: Overview—eMedicine |format= |website= |accessdate=}} 6. ^{{Cite journal|last=Tan|first=Aik-Kah|date=2019-01-09|title=Ophthalmia Neonatorum|journal=New England Journal of Medicine|volume=380|issue=2|pages=e2|language=en|doi=10.1056/NEJMicm1808613|pmid=30625059}} 7. ^{{Cite journal|last=Mallika|first=PS|last2=Asok|first2=T|last3=Faisal|first3=HA|last4=Aziz|first4=S|last5=Tan|first5=AK|last6=Intan|first6=G|date=2008-08-31|title=Neonatal Conjunctivitis – a Review|journal=Malaysian Family Physician : The Official Journal of the Academy of Family Physicians of Malaysia|volume=3|issue=2|pages=77–81|issn=1985-207X|pmc=4170304|pmid=25606121}} 8. ^{{Cite web|url=http://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/conjunctivitis_90,P01678/|title=Conjunctivitis in Children {{!}} Johns Hopkins Medicine Health Library|website=www.hopkinsmedicine.org|access-date=2016-11-11}} 9. ^{{cite web |url=http://aapredbook.aappublications.org/ |title=Red Book—Report of the Committee on Infectious Diseases, 29th Edition. The American Academy of Pediatrics. |accessdate=2007-07-12 |format= |website=}} 10. ^American Academy of Pediatrics. Chlamydia trachomatis. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.288. 11. ^Heggie, Alfred D., et al. "Topical sulfacetamide vs oral erythromycin for neonatal chlamydial conjunctivitis." American Journal of diseases of children 139.6 (1985): 564-566. 12. ^Hammerschlag, Margaret R., et al. "Longitudinal studies on chlamydial infections in the first year of life." The Pediatric Infectious Disease Journal 1.6 (1982): 395-401. 13. ^{{cite web |url=http://emedicine.medscape.com/article/1192190-treatment#aw2aab6b6b3 |title=Neonatal Conjunctivitis Treatment & Management: Treatment of Neonatal Herpetic Conjunctivitis. |accessdate=2013-08-11 }} 14. ^Dharmasena A, Hall N, Goldacre R, Goldacre MJ. Time trends in ophthalmia neonatorum and dacryocystitis of the newborn in England, 2000–2011: database study. Sex Transm Infect. 2015 Aug;91(5):342–5. External links{{Medical resources| DiseasesDB = 9237 | ICD10 = {{ICD10|A|54|3|a|50}}, {{ICD10|P|39|1|p|35}} | ICD9 = {{ICD9|098.40}}, {{ICD9|771.6}} | ICDO = | OMIM = | MedlinePlus = 001606 | eMedicineSubj = oph | eMedicineTopic = 325 | MeshID = D009878 }}{{Eye pathology}}{{Certain conditions originating in the perinatal period}} 4 : Diseases of the eye and adnexa|Neonatology|Disorders of conjunctiva|Herpes simplex virus-associated diseases |
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