A 4-day-old newborn boy presents to the emergency department for evaluation of ocular discharge, which his mother first noticed two days ago. The boy was born at 40 weeks’ gestation at home and did not receive erythromycin eye drops, the hepatitis B vaccine, or vitamin K injection. Physical examination reveals bilateral, profuse, purulent discharge, with significant conjunctival injection and eyelid edema.
Which of the following treatments is indicated for treatment of this newborn’s condition?
B) Intramuscular ceftriaxone
This newborn is likely suffering from gonococcal conjunctivitis, which typically presents between days 2 and 5 of life. While erythromycin eye drops at time of birth helps to prevent of gonococcal conjunctivitis, treatment is with an intramuscular or intravenous third generation cephalosporin (ceftriaxone, cefotaxime, or ceftazidime).
Answer choice A: Artificial tears, is incorrect. Artificial tears can be beneficial in treating chemical conjunctivitis which can result from antibiotic eye drops given to newborns. This is more likely to present in the first 24 hours of life. Purulent eye discharge would be unusual in chemical conjunctivitis.
Answer choice C: Oral erythromycin, is incorrect. This is a preferred treatment for chlamydial conjunctivitis, which is more likely to present between days 4 and 15 of life. Discharge is typically watery, though it may become mucopurulent over time.
Answer choice D: Reassurance, is incorrect. This newborn’s eyelid edema, profuse purulent discharge, and conjunctival injection warrant intervention. Untreated gonococcal conjunctivitis can result in permanent corneal scarring and/or vision loss.
Answer choice E: Warm compresses, is incorrect. A warm compress can be helpful in management of an external hordeolum (stye) and/or as palliative therapy for viral conjunctivitis. It would be insufficient to treat gonococcal conjunctivitis.
Key Learning Point
Newborn gonococcal conjunctivitis presents between days 2 and 5 of life and is characterized by significant eyelid edema, conjunctival injection, and purulent discharge. Treatment is with an intramuscular or intravenous third generation cephalosporin.
