are poorly predictive of either immediate or long-term adverse neurological outcome, they provide the most objective evidence of the fetal metabolic status at birth.
Ophthalmia neonatorum is mucopurulent conjunctivitis of newborns. Some form of conjunctivitis afects 1 to 12 percent of all neonates, and gonococcal and chlamydial infections are among the most common (Zuppa, 201r1).
Neisseria gonorrhoeae infection acquired at birth was a common cause of childhood blindness in the past. However, the practice of instilling a I-percent ophthalmic solution of silver nitrate largely eliminated this. Various other antimicrobial agents have also proven efective, and gonococcal prophylaxis is now mandatory for all neonates in most states (American Academy ofPediatrics, 20 17b). Forprophyxis soon ater delivery, recommendations include a single application of either I-percent silver nitrate solution or 0.5-percent erythromycin ointment. In North America, a previously used I-percent tetracycline ophthalmic ointment is no longer available (Mabry-Hernandez, 2010; Moore, 2015).
For a neonate born to a mother with untreated gonorrhea, treatment of presumptive neonatal gonococcal conjunctivitis is a single ceftriaxone dose, 100 mg/kg, given either intramuscularly or intravenously. Before treatment, testing for both gonococcal and chlamydia infections should be obtained.
With chamydial conjunctivitis, adequate neonatal prophylaxis is complex. Ideally, prenatal screening and treatment for Chamydia trachomatis obviates conjunctival infection (Hammerschlag, 2011). In neonates delivered vaginally of mothers with an active chlamydial infection, 12 to 25 percent will develop conjunctivitis up to 20 weeks ater birth (Teoh, 2003). Prophyactic topical eye treatments do not reliaby reduce the incidence of chlamydial conjunctivitis. In a study from Kenya, 2.5-percent povidone-iodine solution was reported to be superior to either I-percent silver nitrate solution or 0.5-percent erythromycin ointment in preventing chlamydial conjunctivitis (Isenberg, 1995). In another study from Iran, povidone-iodine eye drops were twice as efective in preventing clinical conjunctivitis as erythromycin drops-9 versus 18 percent failure rate, respectively (Ali, 2007).
Conjunctivitis in a newborn up to age 3 months should prompt consideration for chlamydial infection (Moore, 2015). Treatment for pediatric chlamydial infection is with oral azithromycin for 5 days or oral erythromycin for 14 days.
Routine immunization with thimerosal-free vaccine against hepatitis B before hospital discharge is standard practice for all medically stable newborns with birthweights greater than 2000 g (merican Academy of Pediatrics, 20 17b). If the mother is seropositive for hepatitis B surface antigen, then the neonate is also passively immunized with hepatitis B immune globulin. As discussed in Chapter 55 (p. 1064), some advocate treatment of high-risk or even all seropositive women with antiviral nucleoside or nucleotide analogues during pregnancy to minimize fetal transmission (Dusheiko, 2012; Tran, 2012).