Approach to conjunctivitis in newborns
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-068023 (Published 23 March 2022) Cite this as: BMJ 2022;376:e068023
- Gemma Susan Louise Manasseh, ophthalmology specialty registrar1,
- Sajeevika Amarakoon, ophthalmology consultant1,
- Victoria Photiou, general practitioner2,
- Natalia Arruti, ophthalmology consultant3,
- Arundhati Dev Borman, ophthalmology consultant1
- 1Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- 2Downend Health Group, Bristol, UK
- 3Hospital Universitario La Paz, Madrid, Spain
- Correspondence to: G S L Manasseh gslmanasseh5{at}gmail.com
What you need to know
Consider neonatal conjunctivitis in all infants presenting with eye discharge within the first 4 weeks of life
Carefully examine the conjunctiva: if red, refer to hospital eye services for same day review
Investigations and treatment for suspected neonatal conjunctivitis in primary care are not necessary and may interfere with subsequent microbiology sampling
Eye discharge with normal conjunctiva is likely due to congenital nasolacrimal duct obstruction
A 1 week old infant was brought to his general practitioner with red eyes and mild bilateral purulent discharge. The infant was born at term and had a spontaneous vaginal delivery with no complications. On examination, yellow discharge was noted with mild conjunctivitis of both eyes. The infant’s parents are concerned about the redness of the eyes. How should this patient be managed?
What is ophthalmia neonatorum?
Ophthalmia neonatorum, also known as neonatal conjunctivitis, describes conjunctivitis occurring within the first 28 days of life.1 It is chemical or infectious in origin, with infections usually contracted from the birth canal of infected mothers during delivery, or from postnatal caregivers. In 2011, analysis of hospital episode statistics from NHS hospitals in England revealed an incidence of 257 hospitalisations per 100 000 live births due to this condition.2 Untreated infections can cause permanent sight loss and can rapidly disseminate, causing considerable morbidity and even mortality.3
Not all neonatal eye discharge is due to conjunctivitis, however, with congenital nasolacrimal duct obstruction being a common and benign cause of sticky eyes in newborns.4 Distinguishing these conditions when babies present to primary care services helps avoid unnecessary referrals to secondary care and undue distress for new parents.
What causes it?
Infectious causes
Microorganisms responsible for causing infective conjunctivitis are commonly transferred to the baby during vaginal delivery. The American Academy of Pediatrics Committee on Infectious Diseases periodically publishes epidemiological data on neonatal conjunctivitis in the US, the …
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