Ophthalmia Neonatorum: IAP Guidelines
Ophthalmia neonatorum refers to any conjunctivitis occurring in the first 28 days of life. It can be a sight-threatening condition of the eye seen in the first 4 weeks of life. Reported incidence in India is 0.5–33%.
The Indian Academy of Pediatrics (IAP) has released Standard Treatment Guidelines 2022 for Ophthalmia Neonatorum. The lead author for these guidelines on Ophthalmia Neonatorum is Dr. Arvind Shenoi along with co-author Dr. Tunu Gadi and Dr. Sachin Shah. The guidelines come Under the Auspices of the IAP Action Plan 2022, and the members of the IAP Standard Treatment Guidelines Committee include Chairperson Remesh Kumar R, IAP Coordinator Vineet Saxena, National Coordinators SS Kamath, Vinod H Ratageri, Member Secretaries Krishna Mohan R, Vishnu Mohan PT and Members Santanu Deb, Surender Singh Bisht, Prashant Kariya, Narmada Ashok, Pawan Kalyan.
Following are the major recommendations of guidelines:
Etiology:
Signs and Symptoms:
| TABLE 1: Signs and symptoms of ophthalmia neonatorum. | |||
|
Causative agent |
Signs and symptoms | Time of appearance |
Special consideration |
| Chlamydia trachomatis (chlamydial ophthalmia) | Minimal mucopurulent discharge to severe eyelid edema with copious discharge and pseudomembrane formation | 5–14 days after birth | Most common cause of late onset conjunctivitis Maternal cervix or urethra serves as reservoir of the organism Chlamydia pneumonitis may accompany neonatal conjunctivitis |
| Neisseria gonorrhoeae (gonococcal ophthalmia) | Severe eyelid edema, profuse mucopurulent discharge, chemosis, corneal ulceration, and blindness, if untreated | 2–5 days after birth, earlier in premature rupture of membrane | Most virulent infectious cause of ophthalmia neonatorum |
| Chemical | Mildly red eye with some swelling of eyelids following topical prophylaxis | 6–8 hours after instillation of topical prophylaxis | Disappears spontaneously after 48 hours |
| Herpes simplex (herpetic keratoconjunctivitis) | Red eye, serosanguinous discharge, vesicles on lid margin or skin, and hazy cornea due to edema Presence of dendritic keratitis is pathognomonic | Appears anytime during the first 2 weeks of life | Rare cause. Can be associated with generalized herpes simplex infection |
| Pathogenic bacteria Coagulase-negative Staphylococcus Alpha-hemolytic Streptococcus Haemophilus influenzae Streptococcus pneumoniae Staphylococcus aureus Pseudomonas species Escherichia coli species | Conjunctival redness and discharge | Within 72 hours of birth | Most common cause of conjunctivitis Occurs in vaginal deliveries Premature rupture of membranes is a risk factor Midwife examination is another risk factor |
| TABLE 2: Treatment for ophthalmia neonatorum. | |||
| Organism | First choice | Adjunct | Special considerations |
| Gonococcal | As per WHO STI guidelines Single dose of ceftriaxone injection IM 50 mg/kg/day (maximum 150 mg) Or Kanamycin 25 mg/kg (maximum 75 mg) IM single dose Or Spectinomycin 25 mg/kg (maximum 75 mg) IM single dose | Normal saline irrigation of eyes every 1–2 hours Topical antibiotic not necessary |
|
| Organism | First choice | Adjunct | Special considerations |
| Chlamydial | As per WHO STI guidelines Azithromycin 20 mg/kg once daily for 3 days is preferred over erythro- mycin 50 mg/kg/day orally in four divided doses for 2 weeks | Frequent normal saline irrigation of eyes |
pneumonia |
| Herpetic | Parenteral acyclovir 20 mg/kg three times a day for 14 days (21 days if disseminated or CNS disease) along with topical ganciclovir 0.15% or 1% trifluridine five times a day for 10–14 days |
| |
| Coagulase-negative Staphylococcus Alpha-hemolytic Streptococcus Haemophilus influenzae Streptococcus pneumoniae Staphylococcus aureus Pseudomonas species Escherichia coli species | Ophthalmic drops— tobramycin or gentamicin × three to four times a day × 7 days |
|
- American Academy of Pediatrics. Gonococcal infections. In: Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds). Red Book: 2018 Report of the Committee on Infectious Diseases, 31st edition. Itasca, IL: American Academy of Pediatrics; 2018. pp. 355.
- Ghaemi S, Navaei P, Rahimirad S, Behjati M, Kelishadi R. Evaluation of preventive effects of colostrum against neonatal conjunctivitis: a randomized clinical trial. J Educ Health Promot. 2014;3:63.
- Kapoor VS, Evans JR, Vedula SS. Intervention for preventing ophthalmia neonatorum. Cochrane Database Syst Rev. 2020;9(9):CD001862.
- Mammooty NC, George M, Joseph J, Tawab A. Proportion of ophthalmia neonatorum following prophylaxis with azithromycin eye ointment in newborns at a tertiary care centre in Central Kerala. Int J Contemp Pediatr. 2021;8(10):1720-4.
- Wadhwani M, D'Souza P, Jain R, Dutta R, Saili A, Singh A. Conjunctivitis in newborn—a comparative study. Ind J Pathol Microbiol. 2011;54(2):254-7.
- World Health Organization. WHO Recommendations on Newborn Health: Guidelines Approved by the WHO Guidelines Review Committee. Geneva: World Health Organization; 2017.
- Zikic A, Schünemann H, Wi T, Lincetto O, Broutet N, Santesso N. Treatment of neonatal chlamydial conjunctivitis: a systematic review and meta-analysis. J Pediatric Infect Dis Soc. 2018;7(3):e107-15.
The guidelines can be accessed on the official site of IAP: https://iapindia.org/standard-treatment-guidelines/
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