Ophthalmia Neonatorum

Ophthalmia neonatorum (eye infection at <30 days of age) 

Gonococcal ophthalmia usually manifests 2-5 days after birth with acute, severe conjunctivitis 

C. trachomatis ophthalmia usually manifests 5-12 days after birth with less severe conjunctivitis 

Either can present with discharge +/- conjunctival injection. If clinical concern in infant <30 days, at BCH the following tests should be obtained by swabbing everted eyelid: 

1. Chlamydia/Gonorrhea RNA NAAT (independently validated both BCH OAK and SF labs but not FDA-approved)

AND  

2. “Eye culture” (respiratory bacterial culture with Gram stain,  with comment to “look for N. gonorrhoeae”)  

Presumptive treatment (without a confirmed diagnosis) for N. gonorrhoeae is indicated for intracellular gram-negative diplococci on Gram stain, or high index of clinical suspicion pending cultures 

See guidance on HSV evaluation & management in neonates  

Chlamydia trachomatis 

Neisseria gonorrhoeae 

Consider HSV, other bacterial pathogens (per culture results), or noninfectious causes 

Proven or presumptive N. gonorrhoeae: 

Ceftriaxone 50 mg/kg/dose (max 125 mg/dose) IM/IV x 1 dose 

Refer to guidance addressing use of Ceftriaxone in neonates. Intravenous calcium-containing solutions should not be administered within 48 hours before or after Ceftriaxone administration 

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Proven C trachomatis: 

Azithromycin  
20 mg/kg/dose enterally daily x 3 days* 

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Other:  

Management based on clinical characteristics, culture results as indicated 

Topical therapy is not indicated for C. trachomatis or N. gonorrhoeae treatment - both require systemic therapy  

Infants with N. gonorrhoeae ophthalmia neonatorum require Ophthalmology consultation, admission for eye irrigation, and should be evaluated clinically for signs of disseminated infection (e.g., sepsis, arthritis, and/or meningitis) 

*Enteral Azithromycin recommended over Erythromycin given equivalent spectrum of activity with more convenient dosing and better side effect profile (decreased potential risk of QT prolongation and pyloric stenosis; fewer medication interactions) 

C. trachomatis ophthalmia neonatorum is generally self-limited, treatment is indicated to reduce risk of subsequent pneumonia or invasive disease 

Refer birth parent for evaluation as clinically indicated