Neonatal conjunctivitis is a form of bacterial conjunctivitis contracted by new-borns during delivery and appears during the first 4 weeks of life.
Originally, the infection in new-borns was associated with a specific sexually transmitted infection (STI), Neisseria gonorrhoea. However, the term now includes all types of conjunctivitis in this age group, whatever the cause. The bacteria most frequently to blame for neo-natal conjunctivitis are staphylococcus, streptococcus, haemophilus, and Chlamydia trachomatis. In the majority of cases, transmission from mother to baby occurs during delivery.
The most dangerous type of conjunctivitis is new-born conjunctivitis caused by gonococcus.
This illness is characterised by conjunctival discharge which develops quickly and thickly during the week following birth. After just a few hours, the eyelids become very swollen. If treatment is not sought immediately then corneal ulceration and perforation can occur and the child may lose their eye.
In many cases, the infection can spread to the central nervous system.
The removal and culturing of conjunctival secretions is needed to determine the specific type of bacteria and thus which medication is most appropriate.
Magnitude/Public Health Issue
Neonatal conjunctivitis is a relatively common perinatal condition occurring in 1% to 2% of new-borns in developed countries, rising to 12% in new-borns in developing countries.
In Africa, the increased rate (3 to 22%) of sexually transmitted infections among women is reflected in the higher rate of neonatal conjunctivitis. The rate of transmission from mother to new-born can be between 30% and 50% without preventative measures.
Corneal complications of neonatal conjunctivitis account for one of the biggest causes of childhood blindness in the least developed countries.
The earlier that treatment begins; the better. The use of topical steroids is not advised under any circumstances.
Local treatment consists of washing the infected eye frequently to remove the secretions and continued applications of ophthalmic ointment to avoid stickiness. Gonococcol conjunctivitis necessitates systematic treatment and often requires hospitalisation.
The main way of preventing this type of conjunctivitis is to thoroughly clean the new-borns’ eyes immediately after birth.
The usual recommended prophylaxis in most countries is the application of an antiseptic solution within one hour of birth. By doing this, the risk of transmission of the disease from mother to baby is significantly reduced. In countries and areas where the rates of sexually transmitted infections are higher, the ocular prophylaxis is considered to be a very cost-effective way to prevent blindness.
In 1880, Crede’s method of using silver nitrate as a way of preventing neonatal conjunctivitis was introduced, and was one of the most significant achievements of preventative medicine. This method of treatment reduced the rate of transmission from 10% to 0.3%. This form of prophylaxis also slightly reduced the incident rate of purulent conjunctivitis caused by other types of bacteria. However, silver nitrate is not perfect. It did not prevent transmission in every case and even led to cases of chemical conjunctivitis which increased amongst 50%-90% of patients. Another antiseptic, povidone iodine, and antibiotics (tetracycline and erythromycin) are used in the prevention of neonatal conjunctivitis and are widely regarded as acceptable and effective alternatives to silver nitrate. However, these preventative measures are often ignored or unable to be administered in poorer developing countries.
The OPC in Mali prepared to prevent...
The OPC has already trained over 1,000 traditional midwives in the Kayes and Sikasso regions, and equipped them with antibiotic ointment, so that they can take preventative measures against purulent neo-natal conjunctivitis from the moment of birth:
Cleaning babies eyes with saline or boiled water
Applying antibiotic ointment to each eye. The cost of this preventative treatment: €0.038 per new-born!
... and treat purulent conjunctivitis
We have also opened 13 eye care centres and trained 16 specialist nurses to diagnose and treat, from the first symptoms, babies affected by purulent conjunctivitis:
Intramuscular injection of antibiotics
Careful cleaning of eyes and frequent application of antibiotic ointment for ten days. The cost of this remedial treatment: €63 per baby.
Thanks to our generous donators, we have been able to protect or care for over 50,000 new-borns threatened by the dreadful purulent conjunctivitis in 2010.
In 2011, we aim to extend our work to the region of Mopti, where this plague continues to affect one in 15 babies. You can help us to save the sight and lives of new-borns:
Further information on conjunctivitis can be found here.