Pirate Baby’s Never Bored Review

by Kylie Birnbaum • June 30, 2015 • Comments Off

It’s a busy weekday shift in the Peds ED on Jolly Roger Island. A captain brings in his 11 day old newborn scallywag, concerned about her left eye being ‘swollen, crusty, and oozing pus.’ He notes that she cries anytime he tries to touch it.

piratebaby

Her vital signs are HR 144, RR 50, SBP 70, O2 sat 100%, rectal temp 98.6.

Yes, these are normal vitals for a newborn.

On exam you see a gnarly pirate baby, with mild left eyelid swelling and erythema. When you retract the lid she cries, and purulent discharge does indeed ooze from her eye. You note chemosis and conjunctival erythema.

What is pirate baby's diagnosis?

Chlamydia conjunctivitis! C. trachomatis manifests at 5-14 days old, can be unilateral or bilateral. It can be associated with chlamydial pneumonia, so be sure to ask about coughing, fevers, tachypnea, and do a thorough physical exam. Why not gonorrhea, viral, or other bacterial? Read more below.

How are you going to treat this?

Erythromycin 50mg/kg PO (divided in 4 doses) for 14 days. Topical ointment will NOT work, so don’t even try. There must be close follow up within 24 hours and immediately after treatment is finished, as 10-20% of these kiddos will need another course of antibiotics. Azithromycin 20mg/kg for 3 days may also be an effective alternative.

More causes of pirate baby, er, neonatal conjunctivitis

Gonococcal conjunctivitis presents earlier, within 2-7 days of life, with a bilateral findings and intense mucopurulent discharge. It is more rare given that prophylaxis with erythromycin eye ointment is applied to all newborns at birth. It is also more severe and requires admission and additional workup for systemic infection. Treatment is ceftriaxone 50mg/kg IV.

After 2 weeks of life, S. aureus, nontypeable H. influenzae, and S. pneumoniae become the common bacterial conjunctivitis pathogens, and can be treated topically.

Herpes conjunctivitis accounts for 1% of neonatal conjunctivitis, presents at day 6-14 of life with bilateral symptoms, and can have devastating longterm effects. Ask about maternal HSV infection, and look for corneal dendrates and kerititis. Again, these babies must be admitted for a full sepsis workup, and receive acyclovir IV.

Refs

Tintinalli’s 7th ed.

Uptodate.com

By Dr. Kylie

Special thanks to Dr. Willis

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.