Good morning, hope you all enjoyed last nights exciting NCAA Men’s Basketball National Championship. For those who are interested and wonder what I thought of it, please refer to bottom of page.
Today its going to be a gorgeous 77 degree weather today, break out your sunscreens! Low tonight of 59. Tomorrow, high of 80 degrees, but 50% of scattered thunderstorms.
If you need umbrellas, there’s a bunch in the resident room that will be donated at the end of the week!
And now, on with the show!
9 day old female with yellow crusty eyes for the past 4 days. Mom states it had only been in the mornings, however, its now been throughout the day. Returns after wiping. Otherwise no other signs symptoms or complaints. Vital signs stable. Feeding, defecating and urinating well.
Mom had prenatal care with no peripartum infections. The child had seen her pediatrician already and immunizations are up to date.
Exam as below:
Rest of exam is normal. What do you do next?
A. Treat with erythromycin and discharge with close follow up.
B. Sepsis workup including lumbar puncture
C. Discharge with no treatment and close follow up
D. Admit and observe.
In neonates, 30 days and under, with suspicion of gonorrhea, it is a true emergency because gonorrhea penetrates corneal epithelium and permanent loss of vision occurs within 24 to 48 hours if untreated.
These patients will also require admission, sepsis workup, parental antibiotics that covers gonorrhea, chlamydia, as well as possible Neisseria meningitidis such as ampicillin/cefotaxime. Topical fluoro or poly/trim can also be initiated as well.
Always important, outside of neonatal age range, consider child sexual abuse in patients with confirmed chlamydia/gonococcal infections. Also, consider the TORCH infections which also includes toxoplasmosis and HSV.
In conclusion, neonatal conjunctivitis is not as benign as adult or older children conjunctivitis and should be treated with much care and concern.
-Thank you to Dr. Jenny Sands for a very informative morning report.
It was a block.