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close this bookMother-Baby Package: Implementing Safe Motherhood in Countries (WHO, 1996, 108 p.)
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close this folderPrevention, early detection and management of complications
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View the documentOphthalmia neonatorum

Ophthalmia neonatorum

Ophthalmia neonatorum is a frequently identified perinatal infection related to maternal infection by Neisseria gonorrhoeae and Chlamydia trachomatis. Complications - corneal damage and blindness - develop without treatment or even delay in treatment. Many infants will also progress into systematic gonorrhoea. Ophthalmia neonatorum in most cases is not a deadly disease but causes severe disability.

A high prevalence of STD in women results in a high incidence of ophthalmia neonatorum in the absence of eye prophylaxis at birth. The prevalence of gonorrhoea in pregnant women in Africa range from 3% to as high as 22%. The few published results from other continents suggest that some countries have similar prevalence rates. The transmission rate from an infected mother to her newborn, in the absence of prophylaxis, is between 30% and 50%. Although effective prophylaxis is available and recommended in most countries, it is frequently neglected. The risk of infection during delivery among newborns exposed to an infected mother is 7% when silver nitrate is given and 3% when tetracycline ointment is used.

Objective: To reduce ophthalmia neonatorum by 80%.

Target:

Application of eye prophylaxis for all newborns delivered in institutions or by a trained attendant at home. Early diagnosis and treatment of 90% of cases of ophthalmia neonatorum by the year 2000.

Strategy

1. Case-finding and management of gonococcal and chlamydial infections in pregnant women should be promoted.

2. Routine eye prophylaxis in the newborn at birth should be used by all health workers, including traditional birth attendants.

3. Health workers at all health facilities should be trained in early recognition and treatment of ophthalmia neonatorum.

4. Traditional birth attendants should be trained in recognition and referral of neonates with eye discharge to health facilities.

Table 17: Ophthalmia neonatorum

SUSPECT

If purulent discharge in first two weeks
In areas of significant prevalence of gonococcal ophthalmia neonatorum

ASSESS FOR


Swelling and redness and purulent discharge of eyes

- Purulent red, swollen eyelids
- Discharge present

CLASSIFY AS

Ophthalmia

TREAT AT


· Type I health centre

- Treat or refer the newborn for gonorrhoea
- Treat or refer mother and partner(s) for gonorrhoea and chlamydia
- Refer to hospital if no response within 3 days

· Type II health centre

- Treat the newborn for gonorrhoea
- Treat mother and partner(s) for gonorrhoea and chlamydia
- Refer to hospital if no response within 3 days

· Hospital

- Treat the newborn for gonorrhoea
- Treat mother and partner(s) for gonorrhoea and chlamydia
- In case of treatment failure in newborn, treat for chlamydia

Ophthalmia neonatorum is defined as a purulent discharge from the eyes occurring within 14 days of delivery.

Carefully clean eyes of all newborns immediately after delivery and apply either 1% silver nitrate solution or 1% tetracycline eye ointment within one hour of delivery.