Conjunctivitis in Newborns, Causes, Symptoms, Diagnosis, and Treatment

Conjunctivitis, commonly known as “pink eye,” is an inflammation or infection of the conjunctiva, the thin membrane that lines the inner surface of the eyelids and covers the white part of the eye. In newborns, conjunctivitis can be a significant concern due to their delicate immune systems and the potential for rapid spread. This article provides an overview of conjunctivitis in newborns, including its causes, symptoms, diagnosis, treatment, and preventive measures.

What is Conjunctivitis?

Conjunctivitis is characterized by inflammation of the conjunctiva, leading to symptoms such as redness, swelling, and discharge. In newborns, the condition can result from various infectious and non-infectious causes.

Causes of Conjunctivitis in Newborns

1. Infectious Conjunctivitis

Bacterial Conjunctivitis: Caused by bacteria such as Neisseria gonorrhoeae and Chlamydia trachomatis, which can be transmitted from the mother during delivery. Other bacteria, such as Staphylococcus aureus and Haemophilus influenzae, can also cause infection.

Viral Conjunctivitis: Often caused by viruses like adenovirus or herpes simplex virus (HSV). HSV conjunctivitis may present as part of a more widespread infection and requires prompt treatment.

Fungal Conjunctivitis: Rare but can occur in immunocompromised newborns or those with exposure to contaminated environments.

2. Non-Infectious Conjunctivitis

Chemical Conjunctivitis: Can occur due to exposure to chemicals, such as those found in eye drops or ophthalmic solutions administered during or after delivery.

Allergic Conjunctivitis: Rare in newborns but may occur if the infant is exposed to allergens.

Symptoms of Conjunctivitis in Newborns

1. Classic Symptoms

Symptoms of conjunctivitis in newborns may include:

Redness: Red or pink appearance of the white part of the eye.

Swelling: Swelling of the eyelids or conjunctiva.

Discharge: Yellow, green, or clear discharge from the eye, which may cause the eyelids to stick together, particularly after sleep.

Tearing: Excessive tearing or watery eyes.

Irritability: The infant may be more fussy or uncomfortable due to eye irritation.

2. Additional Signs

Crusting: Crusting or sticky secretions around the eyes.

Sensitivity to Light: The infant may show discomfort or sensitivity to bright lights.

Redness of the Eyelids: Along with redness of the eye itself.

Diagnosis of Conjunctivitis

1. Clinical Evaluation

Diagnosis begins with a thorough clinical evaluation:

Medical History: Assessing the infant’s birth history, exposure to potential pathogens, and any symptoms reported by parents.

Physical Examination: Detailed eye examination to identify signs of conjunctivitis and differentiate between infectious and non-infectious causes.

2. Diagnostic Tests

Diagnostic tests may include:

Culture and Sensitivity: Collecting a sample of eye discharge for culture to identify bacterial pathogens and determine appropriate antibiotic treatment.

Polymerase Chain Reaction (PCR): For detecting viral DNA or RNA if viral conjunctivitis is suspected.

Slit Lamp Examination: To examine the eye’s surface and detect any abnormalities or signs of infection.

Treatment of Conjunctivitis

1. Bacterial Conjunctivitis

Antibiotic Therapy: Treatment typically involves topical antibiotics, such as erythromycin ointment or polymyxin B-trimethoprim drops. The choice of antibiotic depends on the causative bacteria.

Hygiene Measures: Keeping the eye clean and applying warm compresses to help relieve discomfort and remove crusted discharge.

2. Viral Conjunctivitis

Supportive Care: Viral conjunctivitis generally resolves on its own. Supportive measures include warm compresses and artificial tears to soothe the eye.

Antiviral Medication: If caused by HSV, antiviral medications such as acyclovir may be prescribed to manage the infection.

3. Chemical Conjunctivitis

Rinsing: If caused by chemical exposure, gently rinsing the eyes with sterile saline may help alleviate symptoms.

Avoidance: Avoiding further exposure to the offending chemical.

4. Allergic Conjunctivitis

Allergen Avoidance: Identifying and avoiding potential allergens, though this is less common in newborns.

Antihistamines: Rarely used in newborns but may be considered if an allergy is confirmed.

Preventive Measures

1. Maternal Screening and Treatment

Screening: Pregnant women should be screened and treated for sexually transmitted infections (STIs) such as gonorrhea and chlamydia to reduce the risk of transmission during delivery.

Prophylactic Eye Drops: Administering prophylactic eye drops or ointment, such as erythromycin, to prevent bacterial conjunctivitis in newborns.

2. Hygiene Practices

Hand Hygiene: Ensuring that healthcare providers and caregivers practice rigorous handwashing to prevent the spread of infection.

Avoid Sharing Items: Preventing the sharing of towels, washcloths, or other items that may come into contact with the eye.

3. Environmental Control

Clean Environment: Keeping the newborn’s environment clean and free from potential irritants or contaminants.

Long-Term Outlook

The prognosis for conjunctivitis in newborns is generally good, especially with prompt and appropriate treatment. Most cases resolve without significant complications. However, untreated or severe infections can lead to complications such as corneal damage or visual impairment.

Conclusion

Conjunctivitis in newborns is a common condition that requires prompt diagnosis and treatment to prevent complications. Understanding the causes, recognizing the symptoms, and implementing appropriate treatment and preventive measures are essential for managing conjunctivitis and ensuring the health of the infant. Regular follow-up and monitoring are important to ensure complete recovery and address any ongoing concerns.