10d male p/w R eye tearing and discharge x1 day. Today purulent. Born FT via NSVD, uncomplicated pregnancy and delivery. No fever. No vomiting, diarrhea. No URI. Taking good PO. On exam, AFVSS, R eye diffuse soft tissue swelling, crusting to lashes, conjunctiva injected with purulent discharge:
Chlamydia Conjunctivitis in Newborn
Transmission – from mothers genital flora during vaginal delivery
Incubation period– 5 to 14 days after delivery
Presentation – mild watery discharge that progresses to mucopurulent discharge, swelling of eyelid, thickened conjunctiva (chemosis), pseudomembrane may form on conjunctiva, conjunctiva may become friable and bleed.
Complications– Granulation tissue, corneal and conjunctival scarring may occur if left untreated
Diagnosis – culture is gold standard. Consider testing all newborns less than 1 month age with conjunctivitis.
Treatment- AAP and CDC recommend oral erythromyicin 50 mg/kg/day PO in 4 divided doses for 14 days
Prevention– prenatal maternal screening
Our case, underwent full sepsis work up, WBC 20.7, normal diff, normal CXR, LP, urine, blood cultures. Did well after antibiotic treatment.
References:
Kimberly Kahne, MD- Thank you to our PEM fellow for the case!
Uptodate- Chlamydia trachomatis infections in the newborn
