Challenges in treating ophthalmia neonatorum

Abstract

Introduction: Ophthalmia neonatorum is a severe, sight-threatening condition that occurs in neonates worldwide. Etiological factors include chemical agents, viruses, and bacteria, such as Neisseria gonorrhoeae and Chlamydia trachomatis acquired from infected mothers at birth. Prevalence varies geographically, depending upon socioeconomic conditions, maternal health care, and prophylactic treatments available. Antibiotic resistance, particularly in N. gonorrhoeae, is a major challenge in treating ophthalmia neonatorum.Areas covered: This review explores the epidemiology and diagnosis of ophthalmia neonatorum and analyses the history and practices of prophylaxis and treatment. In this context, the challenges in treating ophthalmia neonatorum today are discussed and innovations that may overcome these challenges in the future are presented. Advantages and challenges of strategies to prevent ophthalmia neonatorum involving prophylaxis of infants and those using screening and treatment of mothers are explored. Expert commentary:Despite the potential to rapidly cause blindness, there are no universal guidelines for the prevention and treatment of ophthalmia neonatorum. Due to the increasing number of treatment failures, particularly those of extensively drug-resistant N. gonorrhoeae, a pragmatic approach is needed. Enhanced availability of screening and treatment of pregnant mothers, coupled with development of new antimicrobial ocular prophylaxis and treatments, provide options for a variety of settings.

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“…A recent systematic review published data favouring the prophylactic use of erythromycin and povidone-iodine over silver nitrate as prophylactic agents against Chlamydia ophthalmia neonatorum, although there is no evidence in the literature of effective prophylaxis against the gonococcal form of ophthalmia neonatorum [18]. Furthermore, recent studies confirm conclusively that universal prophylaxis against ophthalmia neonatorum has very limited benefit [19][20][21]. This assertion can be shared in reference to developed countries, but it may not look valid in developing countries or countries that are deemed developed yet have a large influx of immigrants [20].…”

“…Antibiotics and other public health advances have greatly altered the context for this ophthalmia neonatorum throughout the years [13]. Most women who get prenatal care are checked for Chlamydia and gonorrhoeae and, if infected, are effectively treated with antibiotics before birth [19]. If a new-born develops neonatal ophthalmia in a setting with good postpartum care, blindness is exceedingly improbable if antibiotic treatment is available [16,19].…”

“…Most women who get prenatal care are checked for Chlamydia and gonorrhoeae and, if infected, are effectively treated with antibiotics before birth [19]. If a new-born develops neonatal ophthalmia in a setting with good postpartum care, blindness is exceedingly improbable if antibiotic treatment is available [16,19]. Rates of ophthalmia neonatorum are frequently quite low in developed nations, the rate in the United States is barely 8.5 per 100,000 births [31].…”

A review of clinical practice guidelines for preventing chlamydial and gonococcal ophthalmia neonatorum

“…Ophthalmia neonatorum is defined as conjunctivitis occurring within the first 28 days after birth 1 . Pregnant women who are at risk of sexually transmitted diseases have an elevated chance of perinatal infections, including neonatal ophthalmia 2 .…”