Preventing conjunctivitis (pinkeye) in your newborn

What is neonatal conjunctivitis?

Neonatal conjunctivitis (pinkeye) is infection or irritation of the white part of a newborn’s eyes and the inside part of the eyelids. It is a fairly common problem. The most severe form is caused by gonorrhea and is called ophthalmia neonatorum.

What are signs and symptoms of conjunctivitis?

Newborns with conjunctivitis will have a pink or red color on the white part of their eyes. They can also have:

• thick pus-like drainage from eyes 
• swollen eyelids that may be red 
• watery drainage from eyes

What causes conjunctivitis?

Conjunctivitis can be caused by:

• exposure to chemicals or an irritant (such as eye drops or soap)
• blocked tear ducts
• bacteria from the mother’s vagina during delivery
• other bacteria or viruses caught after birth from a family member or someone else in close contact with the baby.

In most cases, conjunctivitis is a mild illness that will go away on its own. However, it can be serious in a newborn baby if it is caused by a sexually transmitted infection. This can happen if the mother has an untreated sexually transmitted infection and the baby’s eyes become infected when he is born. There are two sexually transmitted infections that can do this:

• Gonorrhea:  If a baby gets conjunctivitis from gonorrhea and it is not treated right away, they may develop permanent scarring and blindness.
   
• Chlamydia: A baby who is infected with chlamydia at birth can often get conjunctivitis. Fortunately, this kind of conjunctivitis does not cause scarring and blindness. But, the baby could get chlamydia pneumonia (a lung infection) between 1 and 6 months of age. The pneumonia will cause a cough and rapid breathing.

Why am I being asked to get tested for gonorrhea and chlamydia during my pregnancy?

In the past, all babies were automatically treated with antibiotic eye drops (silver nitrate) in case their mother had untreated gonorrhea. Silver nitrate drops are not used anymore because they caused irritation to a baby’s eyes. The antibiotic ointment that is now used in Canada is called erythromycin ointment. Because many bacteria are now resistant to erythromycin, it may not work as well as the silver nitrate did and can sometimes irritate the eyes.

Instead of treating all babies with the ointment, a better way of preventing these types of conjunctivitis is for all pregnant women to be tested for gonorrhea and chlamydia infections at their first prenatal visit. If they are infected, they need to be treated before the baby is born. This helps the mother as well as the baby. Most women with gonorrhea or chlamydia have no symptoms. Their partners may also not have symptoms. The only way to diagnose all cases is to test all pregnant women.

If you were not tested for gonorrhea and chlamydia during your pregnancy, you should be tested at the time of delivery or before you take your baby home. To be tested, you need to either have a swab of your cervix done or provide a urine sample. 

When should my baby receive treatment for conjunctivitis?

If you are tested at delivery or after and you are found to be infected with gonorrhea, your baby will be treated right away. This will prevent your baby from getting conjunctivitis and permanent eye damage. Babies exposed to chlamydia at delivery should be followed closely for signs of infection and only be treated if they get signs of infection.

If your test results aren’t available before you leave the hospital, you’ll be contacted if they are positive. Watch your baby for eye discharge in the first week of life and contact your doctor if this develops, or if your baby is unwell.

If your tests are negative but your baby develops red eyes or discharge, contact your doctor. It may be another type of infection or irritation.

Are there other precautions I can take to protect my newborn?

If someone in your family or a visitor has a cold, make sure they thoroughly wash their hands before touching your baby. Cold and flu viruses can sometimes cause conjunctivitis. If possible, keep babies under 3 months old away from people with colds, flu or viruses.