Color Atlas & Synopsis of Pediatric Eye Care

Color Atlas of Family Medicine 2/E

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Coronary Artery Disease Congestive Heart Failure Bacterial Endocarditis Section 2: Peptic Ulcer Disease Urinary Sediment--Hematuria, Pyuria, and Casts Polycystic Kidney Disease Renal Cell Carcinoma Skin Findings in Pregnancy First Trimester Ultrasound Second Trimester Ultrasound Obstetrics--Third Trimester Ultrasound Section 2: Vaginitis and Cervicitis Chlamydia Cervicitis Section 3: Paget's Disease of the Vulva Vulvar Intraepithelial Neoplasia Section 4: Colposcopy--Normal and Noncancerous Findings Colposcopy of Low-Grade Disease Colposcopy of High-Grade Disease Colposcopy of Cervical Cancer Section 5: Mastitis and Breast Abscess Arthritis and Bursitis Olecranon Bursitis Section 2: Distal Radial Fracture Hip Fracture Section 3: Normal Skin Changes Pustular Diseases of Childhood Diaper Rash and Perianal Dermatitis Section 2: Pseudofolliculitis and Acne Keloidalis Nuchae Hidradenitis Suppurativa Acne Inversa Section 3: Necrotizing Fasciitis Section 4: Fifth Disease Erythema Infectiosum Hand, Foot, and Mouth Disease Plantar Wart Section 5: Cutaneous Fungal Infections--Overview Tinea Versicolor Section 6: Cutaneous Larva Migrans Section 7: Urticaria and Angioedema Section 8: Skin Tag Acrochordon Pyogenic Granuloma Section Epidermal Nevus and Nevus Sebaceous Dysplastic Nevus Section Actinis Keratosis and Bowen's Disease Cutaneous Horn Section Basal Cell Carcinoma Squamous Cell Carcinoma Mycosis Fungoides Section Cutaneous Vasculitis Section Connective Tissue Disease Lupus Erythematosus Systemic and Cutaneous Scleroderma and Morphea Section Other Bullous Diseases Section Hair and Nail Conditions Traction Hair Loss and Trichotillomania Normal Nail Variants Pigmented Nail Disorders Onychocryptosis Ingrown Toenail Subungual Hematoma Nail Trauma Section Pigmentary and Light Related Conditions Erythema Ab Igne Section Acquired Vascular Lesions in Adults Other Skin Disorders Cutaneous Drug Reactions Calluses and Corns Intestinal Worms and Parasites Goiter and Hypothyroidism Graves' Exophthalmus and Goiter Cerebral Vascular Accident Normal Pressure Hydrocephalus Substance Abuse Disorder Topical and Intralesional Corticosteroids C.

It is known that in neonatal bacterial conjunctivitis, conjunctiva typically remains white and rarely gets red or pink. Moreover, eye pain cannot be elicited in the neonates [ 2 , 24 ]. The CDC criteria are unable to differentiate between infections that result from the passage through the maternal birth canal versus those truly related to neonatal hospitalization, and consider both as HAIs.

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As a result, none of the existing definitions can be perfectly applied to the neonates, and therefore standardized neonate-specific guidelines for HAC diagnosis are much needed [ 17 ]. In another study, the median time from admission to onset of HAC was documented as 16 days range, 3— [ 11 ]. The clustering of HAC episodes in our study during the early days of hospitalization could probably find its source in the maternal birth canal.

This is consistent with the previously published data that also reports the predominance of GNBs in neonatal HAC [ 16 , 17 ]. Furthermore, GNBs were the more frequently isolated microorganisms from HAC cases diagnosed during the first 7 days of hospitalization This trend is similar to that observed in a study from Israel where the distribution of neonatal HAC causing microorganisms shifted from gram-negative to gram-positive bacteria during the NICU stay [ 16 ].

Moreover, we observed that 8 of the 17 HAC cases The high frequency of these pathogens in our study is also similar to the Israel study [ 16 ].

Pediatric Eye Disease: Color Atlas & Synopsis

The isolation of these microorganisms suggests that the early HAC infections are likely acquired during passage through the maternal birth canal. In fact, the frequency of neonatal conjunctivitis has been suggested to be a reflection of the sexually transmitted infections prevalent in the community [ 14 ]. We found that only two cases of HAC were associated with P. Neisseria gonorrheae can be acquired from maternal birth canal [ 17 ], and can lead to neonatal conjunctivitis that presents with continuous, profuse purulent discharge within days after birth [ 24 ].

In the present era of effective broad-spectrum antibiotics and neonatal ophthalmic prophylaxis, the incidence of N. It is, therefore, not surprising that this organism was not isolated from any of our conjunctivitis patients. This high percentage of CoNS suggests repeated handling of neonates by either health care professionals or their families without adequate hand washing. Only a single case of CoNS-related neonatal HAC was diagnosed in our study, likely due to strict implementation of hand washing protocols for the staff as well as the visitors in our neonatal unit.

Other bacteria that have been previously reported to be associated with neonatal HAC but not found in our study are Serratia marscecens , Enterobacter cloacae , Enterobacter aerogenes , Citrobacter koseri , Haemophilus influenzae , Proteus mirabilis , Streptococcus pneumoniae , Streptococcus pyogenes and diphtheroids [ 2 , 8 , 17 , 24 ]. A previously published study has reported 5. We, however, did not encounter any case of fungal conjunctivitis in our study. Although isolated outbreaks of viral HAC caused by adenoviruses have been previously reported [ 6 , 7 ], viral etiology was also not established in any of our cases.

Both strains of P. The variable resistance pattern of other GNBs, i.

Pediatric Eye Disease: Color Atlas & Synopsis - Optometry Australia

A previous study has reported a highly resistant pattern of the gram-positive cocci to erythromycin [ 16 ]. We also observed a similar pattern in our study with most gram-positive strains being resistant to erythromycin, which is a commonly used antibiotic in the prophylaxis and treatment of ophthalmia neonatorum. Prematurity and low birth weight LBW increase the general vulnerability of the neonate to infections including HAC [ 2 , 17 ].

We, however, did not find gestational age or birth weight to be significant risk factors associated with the occurrence of neonatal HAC. No significant association was observed between the gender of the neonate and HAC, unlike some previous reports [ 2 , 17 ]. We found intubation at birth to have statistically significant association with neonatal HAC. Flow of respiratory secretions to the eyes through the nasolacrimal duct, especially during suctioning is the likely explanation [ 2 ]. Orogastric feeding was the only other statistically significant risk factor for the development of HAC in our study, probably by a similar mechanism.

Other previously reported risk factors, which were not found to be significant in our study, include noninvasive ventilation and parenteral nutrition [ 2 , 17 ]. Potential risk factors such as mechanical trauma to the conjunctiva due to eye patch during phototherapy and prior eye exam for retinopathy of prematurity were not analyzed in our study.

We found a significant increase in the mean hospital length of stay among neonates diagnosed with HAC No significant increase in the mortality rate was noted among these patients. Eight out of the 20 neonates with HAC were found to have one or more additional episodes of sepsis during their stay in the hospital. The implicating microorganisms for conjunctivitis and sepsis were, however, different in all eight cases.

The occurrence of sepsis and conjunctivitis was, therefore, not considered a part of the same pathologic process. We believe that a strict adherence to universal precautions and hand sanitation guidelines in the neonatal unit was the major contributory factor resulting in a relatively low incidence rate of HAC in our study.

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Among the HAC cases, we found a very few isolates of P. Hand hygiene has been long identified as the single most effective preventive factor in the transmission of infections. In fact, World Health Organization WHO recognizes inappropriate hand hygienic measures as the leading cause of HAIs and the spread of multidrug-resistant organisms [ 25 ]. Strict hand hygiene protocols are, therefore, pivotal in the control of neonatal HAC.

It is unfortunate that low hand hygiene compliance rates have been reported from across the world due a variety of causes including ignorance among healthcare providers and lack of institutional priority towards hand hygiene. Our study is also associated with a few limitations. The neonates in our study were not followed post-discharge from the neonatal unit. As a result, some cases of conjunctivitis that might have been incubating at the time of discharge were probably missed.

Also, the long-term sequelae of neonatal HAC could not be determined in our study for the same reason. It is often difficult to accurately distinguish between the HAC infections acquired during the stay in the neonatal unit and those acquired from the maternal birth canal. Consequently, some of the HAC cases in our study, especially the ones diagnosed early during hospital stay, might have been acquired in the maternal birth canal leading to an overestimation of the real HAC incidence.

Lastly, conjunctivae of hospitalized neonates are frequently colonized by microorganisms [ 3 ], and it is sometimes difficult to differentiate between colonization and true infection [ 16 ]. Therefore, some of the HAC cases in our study might in fact represent a mere conjunctival colonization rather than a true infection.

In this one-year prospective cohort study, the incidence of neonatal HAC was estimated at 4. The microbiological profile and the anti-microbial sensitivity patterns were characterized in detail for the established cases of HAC. A significant association was observed between conjunctivitis and some common interventions in the neonatal units, such as intubation and orogastric feeding, which suggest that extra eye care is warranted especially in the presence of these local insults.

A strict adherence to hand sanitation guidelines is likely effective in preventing neonatal HAC. Further studies to specifically test this hypothesis are needed and should be strongly encouraged. Lastly, standardized case definition and awareness of the possible serious outcomes of neonatal conjunctivitis will aid in better surveillance. This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

National Center for Biotechnology Information , U. Published online Oct 1. Published by Oxford University Press. For Permissions, please email: This article has been cited by other articles in PMC.

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Patient has pathogens cultured from purulent exudate obtained from the conjunctiva or contiguous tissues, such as eyelid, cornea, meibomian glands or lacrimal glands. At least 1 of the following: Positive laboratory test e. Multinucleated giant cells seen on microscopic examination of conjunctival exudate or scrapings. Conjunctivitis occurring as a part of a more widely disseminated viral illness such as measles, chickenpox or an upper respiratory infection. Open in a separate window. RESULTS A total of intramural neonates were admitted to the neonatal nursery during the defined one-year study period, out of which neonates fulfilled the inclusion criteria and were enrolled into the study.

Antimicrobial susceptibility pattern of bacterial isolates. Risk factors for neonatal HAC. Multivariate analysis of risk factors. Pediatr Ann ; Epidemiology and diagnosis of hospital-acquired conjunctivitis among neonatal intensive care unit patients. Pediatr Infect Dis J ; Conjunctival colonization of infants hospitalized in a neonatal intensive care unit: Infect Control Hosp Epidemiol ; Hand hygiene practices in a neonatal intensive care unit: An outbreak of conjunctivitis caused by multiresistant Pseudomonas aeruginosa in a Brazilian newborn intensive care unit.

Braz J Infect Dis ; 7: Epidemic adenoviral keratoconjunctivitis possibly related to ophthalmological procedures in a neonatal intensive care unit:

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