A mother brings her 4 day old newborn baby boy into the Peds ED for bilateral eye discharge. Mom tells you he was full-term and healthy, but she did not have prenatal care. The baby is well appearing and is eating, urinating and defecating well. A picture of his eyes are above, are you concerned?

You should be concerned. This baby likely has gonoccocal conjunctivitis which has the potential to penetrate the cornea and result in permanent vision loss.

Gonococcal infections in pregnant woman are uncommon, less than 1%. Newborns usually acquire gonococcal infections during delivery. The most frequent site of infection in newborns is the eye causing a purulent conjunctivitis, this results in exudates and swelling of the eyelids. The infection usually arises two to five days after birth.

Newborns with conjunctivitis should be evaluated using a gram stain and culture of their conjunctival exudate. Newborns who test positive for gonococcal conjunctivitis should receive antibiotics and hospitalization. Patients will also require a sepsis workup and evaluation for concomitant infections such as chlamydia, syphilis, and HIV.  Treatment consists of IV or IM ceftriaxone (25-50mg/kg/day, up to 125mg) until systemic infection is ruled out and frequent saline solution eye irrigation. Do not forget about the mother and sexual partners, they should also be evaluated and treated for gonococcal infections.

Of note, chlamydial conjunctivitis usually develops 5 to 14 days after birth. About 50% of neonates will also have concomitant chlamydial infections in the nasopharynx, genital tract, or lungs. . The American Academy of Pediatrics recommends a 14-day course of systemic erythromycin (50 mg/kg/d, divided in 4 doses).

Sources:

David W. Kimberlin MD, FAAP, ed. 2015. Red Book®: 2015 Report of the Committee on Infectious Diseases – 30th Ed. Printed in the United States of America. American Academy of Pediatrics