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Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 121

A sick neonate with red eyes: Opthalmia neonatorum


Department of Paediatrics, Kalawati Saran Children's Hospital and Lady Hardinge Medical College, New Delhi, India

Date of Submission18-Jan-2022
Date of Decision29-Jan-2022
Date of Acceptance31-Jan-2022
Date of Web Publication30-May-2022

Correspondence Address:
Dr. Sidharth Yadav
Department of Paediatrics, Kalawati Saran Childrenfs Hospital and Lady Hardinge Medical College, Bangla Sahib Marg, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipcares.ipcares_17_22

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How to cite this article:
Saha S, Yadav S. A sick neonate with red eyes: Opthalmia neonatorum. Indian Pediatr Case Rep 2022;2:121

How to cite this URL:
Saha S, Yadav S. A sick neonate with red eyes: Opthalmia neonatorum. Indian Pediatr Case Rep [serial online] 2022 [cited 2022 Jul 2];2:121. Available from: http://www.ipcares.org/text.asp?2022/2/2/121/346250

A 4-day old boy presented to us with fever and excessive crying for 2 days, rapidly progressive swelling of both eyes for a day, and refusal to feed for a few hours. He was born at home, at 32 weeks gestation, to an immunized, unbooked, second gravida mother. Pregnancy had been uneventful till the onset of labor. The delivery was conducted by an untrained birth attendant. No eyedrops were instilled. The baby cried immediately at birth, weighed 1.7 kg and was started on breastfeeds and bottle feeds. At admission, the neonate was euthermic but sick and lethargic. The heart rate was 160/min, respiratory rate 50/min, capillary refill time normal, and saturation 95% on room air. Hypoglycemia was detected. There was pronounced bilateral periorbital swelling with conjunctival redness and thick mucopurulent, hemorrhagic discharge [Figure 1]. A clinical diagnosis of late-onset sepsis with ophthalmia neonatorum was kept. Blood samples and conjunctival culture swabs were taken. Intravenous fluids and broad-spectrum antibiotics were started. Salient reports included leukocytosis of 29,000/uL, absolute neutrophil count 5510/uL, thrombocytopenia (platelets 43,000/uL), elevated C reactive protein (88 mg/L), and direct hyperbilirubinemia (total bilirubin 14.4 mg/dL and direct 3.27 mg/dL). Renal function tests were unremarkable. The patient developed septic shock, required inotropes and ventilatory support and succumbed within 48 h. The blood culture was sterile, but conjunctival culture grew Pseudomonas aeruginosa.
Figure 1: Bilateral periorbital swelling with hemorrhagic discharge

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Ophthalmia neonatorum is acute, mucopurulent conjunctivitis that presents in the first 4 weeks of life. The incidence is 1%–2% in India.[1] Chemical conjunctivitis was common when 2% silver nitrate was used for prophylaxis against gonococcal conjunctivitis. Infections are caused by Chlamydia, bacteria and viruses. The clinical presentation includes conjunctival erythema, chemosis, and edema of the eyelids, with thick, purulent eye discharge. The onset of symptoms may help in diagnosis. Chemical conjunctivitis presents within 24 h. Conjunctivitis due to Neisseria presents in the first 48 h, Chlamydia by the 5th–14th day, whereas Pseudomonas and viruses by the 2nd or 3rd week. Pseudomonas comprises 1.2%–5.9% of all neonatal conjunctivitis.[2] Preterm and low birth weight babies are at high risk for Pseudomonas infections.

Etiological diagnosis is established by gram stain (bacteria) and Giemsa stain (Chlamydia) of conjunctival scrapings, cultures, and polymerase chain reaction studies. World Health Organisation guidelines recommend immediate antibiotic administration directed toward Neisseria and Chlamydia single-dose third-generation cephalosporins for Neisseria, and erythromycin or azithromycin for Chlamydia.[3] Delay in treatment can result in corneal perforation, blindness, or death.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Wadhwani M, D'souza P, Jain R, Dutta R, Saili A, Singh A. Conjunctivitis in the newborn- a comparative study. Indian J Pathol Microbiol 2011;54:254-7.  Back to cited text no. 1
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2.
Shah SS, Gloor P, Gallagher PG. Bacteremia, meningitis, and brain abscesses in a hospitalized infant: Complications of Pseudomonas aeruginosa conjunctivitis. J Perinatol 1999;19:462-5.  Back to cited text no. 2
    
3.
WHO recommendations on newborn health: Guidelines approved by the WHO Guidelines Review Committee. Geneva: World Health Organization; 2017.  Back to cited text no. 3
    


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