Conjunctivitis of the Newborn
Conjunctivitis
P31.9
DESCRIPTION
- Inflammation of the conjunctivae in the neonatal period, presenting with a picture that may range from mildly sticky eyes to an abundant purulent discharge and eyelid oedema.
- Common infectious agents include N. gonorrhoeae, S. aureus, and Chlamydia.
- Generally, conjunctivitis of the newborn is either mild (small amount of sticky exudates) or severe (profuse pus and swollen eyelids).
- The latter is often N. gonorrhoeae and threatens damage to the cornea, while the former is often S. aureus or undefined.
|
CAUTION - Treat conjunctivitis with abundant pus immediately to prevent damage to the cornea that may lead to blindness. - Treat parents of a neonate with purulent discharge appropriately. |
GENERAL MEASURES
- Cleanse or wipe eyes of all newborn babies with a clean cloth, cotton wool or swab, taking care not to touch or injure the eye.
MEDICINE TREATMENT
Prevention
Routine administration for every newborn baby:
- Chloramphenicol 1%, ophthalmic ointment, applied as soon as possible after birth.
Treatment
Sticky eye(s) without purulent discharge:
- Chloramphenicol 1%, ophthalmic ointment, applied 6 hourly for 7 days.
Purulent discharge:
i.e. mild discharge without swollen eyelids and no corneal haziness
- Sodium chloride 0.9%, eye washes, immediately then 2–3 hourly, until discharge clears.
AND
- Ceftriaxone, IM, 50 mg/kg immediately as a single dose.
|
Weight |
Dose |
Use one of the following injections mixed with water for injection (WFI): |
Age |
|
|
250 mg/2 mL (250 mg diluted in 2 mL WFI) |
500 mg/2 mL (500 mg diluted in 2 mL WFI) |
|||
|
˃2–2.5 kg |
100 mg |
0.8 mL |
0.4 mL |
>34–36 weeks |
|
˃2.5–3.5 kg |
150 mg |
1.2 mL |
0.6 mL |
>36 weeks–1 month |
|
˃3.5–5.5 kg |
200 mg |
1.6 mL |
0.8 mL |
˃1–3 months |
Follow up in one day.
Abundant purulent discharge and/or swollen eyelids and/or corneal haziness:
- Sodium chloride 0.9%, eye washes, immediately then hourly until referral.
AND
- Ceftriaxone, IM, 50 mg/kg immediately as a single dose, and refer.
|
Weight |
Dose |
Use one of the following injections mixed with water for injection (WFI): |
Age |
|
|
250 mg/2 mL (250 mg diluted in 2 mL WFI) |
500 mg/2 mL (500 mg diluted in 2 mL WFI) |
|||
|
˃2–2.5 kg |
100 mg |
0.8 mL |
0.4 mL |
>34–36 weeks |
|
˃2.5–3.5 kg |
150 mg |
1.2 mL |
0.6 mL |
>36 weeks–1 month |
|
˃3.5–5.5 kg |
200 mg |
1.6 mL |
0.8 mL |
˃1–3 months |
|
CAUTION: USE OF CEFTRIAXONE IN NEONATES AND CHILDREN - If SUSPECTING SERIOUS BACTERIAL INFECTION in neonate, give ceftriaxone, even if jaundiced. - Always include dose and route of administration of ceftriaxone in the referral letter. |
Treat both parents of newborn babies who develop purulent conjunctivitis after 24 hours of birth for N. gonorrhoeae and Chlamydia
Parents:
- Ceftriaxone, IM, 250 mg as a single dose.
- For ceftriaxone IM injection: Dissolve ceftriaxone 250 mg in 0.9 mL lidocaine 1% without epinephrine (adrenaline).
AND
- Azithromycin, oral, 1 g, as a single dose.
REFERRAL
Urgent
- All neonates with abundant purulent discharge and/or swollen eyelids and/or corneal haziness.
- Neonate unresponsive to treatment within 2 days.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_30 September 2024
Chapter 18: Eye Conditions_18.1 Conjunctivitis_18.1.3 Conjunctivitis of the Newborn