The purpose of this study was to explore the current state of clinical care for healthy newborns with uncomplicated ophthalmia neonatorum (ON) using a large electronic health record dataset. Despite the existence of national guidelines for antepartum screening for N. gonorrhoeae and Chlamydia trachomatis, no guidelines exist for the evaluation and management of ON. In this US study, the authors accessed the Cosmos dataset with information on 227,115,381 patients. Over the period from 1/1/2016 to 31/12/2022, 7,325,276 neonates had a recorded birth hospital stay of ≤3 days of which 1870 met the inclusion criteria. Of these, 303 were admitted to hospital via ER with ON; 43% female, 56% White, 27% Black or African American, 3.6% Asian, 1% Native American and 20.3% Hispanic. Most (90%) were full gestation and the others ranged from 33–37 weeks. Presenting features included 56% with fever, 57.6% cough, 40.3% nasal congestion, 22% eye discharge, 14.8% fussiness and 2.6% with feeding issues. Most had minimal or no clinical testing at the sentinel encounter. Gonococcal ON was identified for 29 cases (0.4 per 100,000 neonates or 1.6%). There were 11 cases of Chlamydial ON (0.6%), 9.3% bacterial and 1.2% viral. There were no cases of herpes viral ON. No aetiology was identified for 37%. The most common treatment was ophthalmic macrolides at 57.1%, then ophthalmic polymyxin in 12.4%, ophthalmic polymyxin B sulfate/trimethoprim in 11.1%, ophthalmic gentamycin sulfate for 8.1% and oral antimicrobial agents for 11.4%. This study shows the changing microbiology of ON over the decades. Absence of guidelines leads to significant variation in assessment and management of these cases. The authors have developed and provide a framework for the evaluation and treatment of uncomplicated conjunctivitis in health infants.
Outline of clinical care for healthy newborns with uncomplicated conjunctivitis in the US
Reviewed by Fiona Rowe
Variability in the evaluation and treatment of healthy neonates with uncomplicated conjunctivitis.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
View Full Profile
