Neonatal Conjunctivitis: Causes, Symptoms & Treatment

Neonatal conjunctivitis sometimes called ophthalmia neonatorum is an inflammation of a newborns eye that usually shows up within the first month of life. Its the kind of thing that can make any parents heart skip a beat, but the good news is that most cases are easy to spot and treat when you know what to look for.

In the next few minutes well walk through the redflag signs, the sneaky germs that cause it, how doctors confirm the diagnosis, and the stepbystep treatment plan that gets tiny eyes back to normal. Think of it as a friendly cheatsheet you can pull out whenever the little ones start winking a little too much.

Quick Check Symptoms

What are the classic neonatal conjunctivitis symptoms?

First off, the eyes reaction is usually pretty straightforward: youll notice redness around the white of the eye, swelling of the eyelids, and a discharge that can be watery, mucoid, or pusfilled. The discharge often starts out clear but can turn yellow or green if bacteria are involved. Babies may also rub their eyes more than usual, and you might see them squinting when exposed to bright light.

Symptom checklist (downloadable PDF)

If you prefer a printable version you can grab a neonatal conjunctivitis PDF that lists each sign with a simple tick box. Having it on the fridge makes it easy to monitor any changes day by day.

When should you call the pediatrician?

Not every watery eye is an emergency, but you should ring the pediatrician if you see any of these redflag signs:

• Large amounts of thick, yellow or green pus.
• Fever over38C (100.4F).
• One eye looks distinctly more swollen than the other.
• The baby seems unusually irritable, especially when light hits the eye.

Prompt medical attention can prevent complications like corneal ulceration, which, although rare, can lead to permanent vision loss.

Why Does It Happen?

Which two bacteria are the main culprits?

When you hear neonatal conjunctivitis is caused by which two bacteria, the answer most pediatric textbooks give you is Neisseria gonorrhoeae and Chlamydia trachomatis. These two organisms love the warm, moist environment of the birth canal, and they can hitch a ride down the newborns nasolacrimal ducts during a vaginal delivery.

Other infectious agents

While gonorrhea and chlamydia account for the majority of cases, other microbes can also cause inflammation. Staphylococcus aureus, Streptococcus pneumoniae, and even viruses like herpes simplex are occasional offenders. In regions where agricultural work is common, fungi such as Candida can show up, though theyre far less frequent.

Noninfectious triggers

Sometimes the irritation isnt from a germ at all. A blocked tear duct (the nasolacrimal duct) can cause a buildup of mucus that mimics discharge. Chemical irritants like leftover antiseptic from the delivery room might also spark redness, but these usually resolve quickly once the eye is flushed.

How does delivery mode affect risk?

Cesarean sections dramatically reduce exposure to vaginal flora, which means the risk of gonococcal or chlamydial infection drops by about 80% compared with vaginal birth. However, a C-section isnt a guaranteed shield if the mothers bloodstream is infected, the baby can still acquire the bacteria transplacentally. This risk profile is also relevant in other eye diseases such as dry eye disease, which can complicate vision health in newborns.

How Is It Diagnosed?

Clinical exam what the doctor looks for

The pediatrician will start with a simple visual inspection: looking for eyelid swelling, conjunctival redness, and the type of discharge. A bright light (often a slitlamp) can help highlight any corneal involvement. The physician may also gently press the eyelid to see if theres a sticky discharge that wont come off easilya hallmark of bacterial infection.

Lab work when is a culture needed?

If the discharge is thick, yellow, or the baby is systemically ill, the doctor will take a swab of the conjunctival secretions. Modern labs can run a rapid PCR test for C. trachomatis and a nucleicacid amplification test (NAAT) for N. gonorrhoeae. In less common cases, a full bacterial culture may be ordered to rule out resistant strains.

ICD10 coding tip

Code	Description
H16.0	Neonatal conjunctivitis
H10.13	Acute bacterial conjunctivitis, unspecified

Using the correct ICD10 codehelps insurance companies process claims quickly and ensures the babys medical record is accurate for future reference.

Treatment Guidelines

Firstline topical antibiotics

The most common starting point is a broadspectrum ointment such as erythromycin 0.5% applied to the inner eyelid three times a day. Its safe for newborns and covers both chlamydia and gonorrhea in many cases. Some clinicians prefer azithromycin drops, especially when resistance patterns are a concern.

When to use systemic therapy

If lab results confirm C. trachomatis, a single oral dose of azithromycin (1g) is recommended for the infant, and the mother should receive the same regimen to prevent reinfection. For gonococcal conjunctivitis, a single intramuscular injection of ceftriaxone (50mg) is the gold standard, often followed by a short course of oral antibiotics.

Full treatment algorithm (PDF & PPT)

For a visual guide you can download a that walks you through each step from initial assessment to followup. The same information is available as a onepage neonatal conjunctivitis treatment guideline PDF.

How long should treatment last?

Topical antibiotics are usually prescribed for 5-7 days. Systemic antibioticswhether a single dose or a 7-day courseare given as a oneoff or short regimen depending on the organism. The pediatrician will schedule a followup 48 hours after treatment starts to confirm that the discharge is clearing and the redness is fading.

Managing complications

Although rare, severe cases can lead to corneal ulceration. If ulceration is suspected, an ophthalmologist may prescribe fortified antibiotics (e.g., fortified cefazolin) and apply a protective eye shield. In extreme scenarios where scarring threatens vision, a corneal transplant could become necessaryhence the importance of early detection, particularly relevant in diseases such as cataract diagnosis test recommended for evaluating vision impairments.

Evidence base

These recommendations align with the latest review and the American Academy of Pediatrics (AAP) 2024 clinical guidance, which both stress rapid treatment to prevent longterm sequelae.

Prevention Tips

Prophylactic eye drops at birth

Most hospitals still follow the CDCs guideline of applying a single dose of 0.5% erythromycin ointment to each eye within an hour of birth. This prophylaxis dramatically cuts the risk of gonococcal infection by up to 95% and offers a safety net for mothers whose STI status is unknown.

Maternal screening & treatment

The most effective prevention strategy starts before delivery: routine prenatal screening for gonorrhea and chlamydia at the first prenatal visit and again in the third trimester. If a positive result is found, the mother receives appropriate antibiotics at least two weeks before delivery, which dramatically reduces the newborns exposure.

Checklist for delivery rooms

Heres a quick printable list you can post in the laboranddelivery suite:

• Confirm maternal STI screening results.
• Apply erythromycin ointment immediately after birth.
• Document the lot number and time of application.
• Record any observed ocular discharge within the first 24hours.

RealWorld Perspectives

Case study: 3dayold with gonococcal infection

Emily, a pediatric resident, encountered a threedayold boy with bright green discharge and swollen eyelids. The babys mother had been treated for gonorrhea only a week before delivery. A rapid NAAT confirmed N. gonorrhoeae. Emily administered a single intramuscular ceftriaxone dose, followed by erythromycin ointment for 5 days. Within 48 hours, the discharge cleared, and the infants vision was unharmed. This case underscores the importance of maternal treatment timing and immediate newborn prophylaxis.

Parent story

When Mias daughter Lily turned two weeks old, the little pink eye startled her. I thought it was just newborn tears, Mia admits. But the thick yellow pus made her call the clinic. The pediatrician reassured her, prescribed erythromycin ointment, and Lily was back to her sleepyself in less than a week. Knowing exactly what to look for saved us a lot of worry, Mia says.

Expert commentary

Dr. Samuel Ortiz, boardcertified pediatric ophthalmologist at Childrens Mercy, notes, Early identification and treatment of neonatal conjunctivitis are nonnegotiable. The eye is a delicate organ; even a brief infection can leave lasting marks if we dont act fast. He adds that the combination of prophylactic eye drops and maternal STI screening is the most costeffective publichealth strategy.

Authoritativeness & Further Reading

Trusted sources to cite

When expanding this article into a full guide, consider linking to:

• CDCs official neonatal conjunctivitis fact sheet.
• American Academy of Pediatrics (AAP) clinical practice guidelines (2024).
• StatPearls comprehensive review on ophthalmia neonatorum.
• Recent peerreviewed studies on antibiotic resistance trends.

Downloadable resources

For quick reference, you can download the following:

• Symptom checklist PDF (linked above).
• Treatment algorithm PPT (linked above).
• ICD10 coding cheatsheet PDF.

Conclusion

Neonatal conjunctivitis can feel overwhelming the moment you see a red, watery eye, but armed with the right knowledge its a manageable condition. Recognize the symptoms early, understand that N. gonorrhoeae and C. trachomatis are the usual suspects, and follow the proven treatment guidelinetopical antibiotics, systemic therapy when needed, and timely followup. Prevention starts with maternal screening and a quick swipe of prophylactic eye drops right after birth. If you ever feel unsure, reach out to your pediatrician; theyre there to help you protect that precious little vision.