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Conjunctivitis (Pink Eye) in Newborns

Neonatal conjunctivitis (pink eye) is a red eye in a newborn caused by infection, irritation, or a blocked tear duct. When caused by an infection, neonatal conjunctivitis can be very serious.

Types of Neonatal Conjunctivitis

The most common types of neonatal conjunctivitis are

  • Inclusion (chlamydial) conjunctivitis,
  • Gonococcal conjunctivitis,
  • Chemical conjunctivitis, and
  • Conjunctivitis caused by other bacteria and by viruses.

Causes of Conjunctivitis in Newborns

Newborn sleepingThe cause of neonatal conjunctivitis is difficult to determine because, in many instances, the signs and symptoms don’t vary by cause.

Conjunctivitis in a newborn may be caused by a blocked tear duct, irritation produced by the topical antimicrobials given at birth, or infection. The mother may be without symptoms (asymptomatic) at the time of delivery, yet she may carry bacteria or viruses that can infect the newborn.

Descriptions of the common causes of neonatal conjunctivitis follow:

  • Inclusion (chlamydial) conjunctivitis
    Inclusion conjunctivitis is caused by the bacterium called Chlamydia trachomatis, which may be passed to the baby during childbirth.
  • Gonococcal conjunctivitis
    Gonococcal conjunctivitis is caused by the bacterium called Neisseria gonorrhoeae. A newborn can be infected with these bacteria during childbirth.
  • Chemical conjunctivitis
    When eye drops are given to newborn children to help prevent a bacterial infection, the newborn’s eye(s) may become irritated. This may be diagnosed as chemical conjunctivitis.
  • Other bacterial and viral conjunctivitis
    Bacteria other than Chlamydia trachomatis and Neisseria gonorrhoeae can cause conjunctivitis in a newborn after the first week of life. Bacteria that normally live in a woman's vagina that are not sexually transmitted can cause neonatal conjunctivitis.

    The viruses that cause genital and oral herpes can also cause neonatal conjunctivitis and severe eye damage. Such viruses may also be passed to the baby during childbirth. However, herpes conjunctivitis is less common than conjunctivitis caused by gonorrhea and chlamydia.
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Signs and Symptoms of Conjunctivitis in Newborns

Newborns with conjunctivitis develop drainage from the eyes within 1 day to 2 weeks after birth. Their eyelids become puffy, red, and tender.

Symptoms of the common causes of neonatal conjunctivitis follow:

  • Inclusion (chlamydial) conjunctivitis
    Symptoms of inclusion conjunctivitis include redness of the eye(s), swelling of the eyelids, and discharge of pus, and are likely to appear 5 to 12 days after birth.
  • Gonococcal conjunctivitis
    Symptoms in a newborn with gonococcal conjunctivitis usually include red eyes, thick pus in the eyes, and swelling of the eyelids. This type of conjunctivitis usually begins about 2 to 4 days after birth.
  • Chemical conjunctivitis
    Symptoms of chemical conjunctivitis usually include mildly red eye(s) and some swelling of the eyelids. Symptoms are likely to last for only 24 to 36 hours.
  • Other bacterial and viral conjunctivitis
    Red eye(s) and eyelids swollen with some pus are also typical symptoms of conjunctivitis caused by other bacteria and viruses.
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Prevention and Treatment of Conjunctivitis in Newborns

To prevent neonatal conjunctivitis, most hospitals are required by state law to put drops or ointment in a newborn's eyes to prevent disease. In the past, silver nitrate was used; it has been mostly replaced with antibiotic eye drops, such as erythromycin.

To treat infection, topical antibiotic eye drops and ointments, oral antibiotics, and intravenous (given through a vein) antibiotics are all used, depending on the severity of the infection and the organism responsible for it.

Topical (applied to the eye) and oral or topical and intravenous treatments are sometimes used at the same time. And the newborn’s infected eye may be rinsed with a saline solution to remove the pus that may accumulate.

If the conjunctivitis is caused by a blocked tear duct, gentle warm massage between the eye and nasal area may help. If the blocked tear duct is not cleared by one year of age, surgery may be required.

Treatments for the common causes of neonatal conjunctivitis follow:

  • Inclusion (chlamydial) conjunctivitis
    Oral antibiotics are usually given for treatment of inclusion conjunctivitis.
  • Gonococcal conjunctivitis
    Intravenous (IV) antibiotics will usually be given to the newborn as treatment for gonococcal conjunctivitis. If untreated, corneal ulcerations and blindness may occur.
  • Chemical conjunctivitis
    Since this type of conjunctivitis is caused by chemical irritation, treatment is usually not required. The newborn will usually get better in 24-36 hours.
  • Other bacterial and viral conjunctivitis
    Antibiotic drops or ointments for the eye will usually be given as treatment for conjunctivitis caused by bacteria other than Chlamydia trachomatis and Neisseria gonorrhoeae. For both bacterial and viral conjunctivitis, a warm compress to the eye may relieve swelling and irritation. Be sure to wash hands before and after touching the infected eyes.
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