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.
Her vital signs are HR 144, RR 50, SBP 70, O2 sat 100%, rectal temp 98.6.
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?How are you going to treat this?
More causes of pirate baby, er, neonatal conjunctivitis
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
Kylie Birnbaum
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