Challenges in treating ophthalmia neonatorum

ABSTRACT

Introduction: Ophthalmia neonatorum is a severe, sight-threatening condition that occurs in neonates worldwide. Etiological factors include chemical agents, viruses, and bacteria, such as Neisseria gonorrhoeae and Chlamydia trachomatis acquired from infected mothers at birth. Prevalence varies geographically, depending upon socioeconomic conditions, maternal health care, and prophylactic treatments available. Antibiotic resistance, particularly in N. gonorrhoeae, is a major challenge in treating ophthalmia neonatorum. Areas covered: This review explores the epidemiology and diagnosis of ophthalmia neonatorum and analyzes the history and practices of prophylaxis and treatment. In this context, the challenges in treating ophthalmia neonatorum today are discussed and innovations that may overcome these challenges in the future are presented. Advantages and challenges of strategies to prevent ophthalmia neonatorum involving prophylaxis of infants and those using screening and treatment of mothers are explored.Expert commentary: Despite the potential to rapidly cause blindness, there are no universal guidelines for the prevention and treatment of ophthalmia neonatorum. Due to the increasing number of treatment failures, particularly those of extensively drug-resistant N. gonorrhoeae, a pragmatic approach is needed. Enhanced availability of screening and treatment of pregnant mothers, coupled with the development of new antimicrobial ocular prophylaxis and treatments, provide options for a variety of settings.

KEYWORDS:

• Antibiotic resistance
• neonatal conjunctivitis
• Chlamydia trachomatis
• gonococcal blindness
• Neisseria gonorrhoeae
• prophylaxis
• bacterial eye infections
• novel antimicrobials

Article highlights

• Sexually transmitted infections are on the increase around the world, which will contribute to an increase in cases of ophthalmia neonatorum.

• The most common causes of ophthalmia neonatorum are Chlamydia trachomatis and Neisseria gonorrhoeae, passed to the infant at birth from a mother who may be asymptomatic and unaware of her infection.

• Ophthalmia neonatorum can lead to loss of visual acuity and even blindness within days of birth, particularly when caused by N. gonorrhoeae, where the disease progresses rapidly.

• Prevention of ophthalmia neonatorum induced visual impairment can be achieved by preventing transmission of the bacteria to the infant or through prophylaxis shortly after birth.

• To prevent transmission of ocular infection-causing bacteria to the infant, pregnant women must receive adequate health care, including screening and risk assessment for sexually transmitted infections, treatment for infection, and test of cure.

• Prophylaxis with an antimicrobial agent applied to the ocular surface shortly after birth is intended to prevent the growth of bacteria that may have been transferred from mother to child during passage through the birth canal.

• Not all mothers receive pre-delivery assessments and not all infants receive prophylaxis and even amongst those that do, some infants develop ophthalmia neonatorum requiring treatment.

• Treatment for ophthalmia neonatorum has become more challenging due to increasing resistance to antibiotics, particularly in the case of N. gonorrhoeae.

• Research and investment into innovative non-antibiotic agents for prophylaxis and treatment of ophthalmia neonatorum should be encouraged to replace or augment current antimicrobial agents.

Declaration of interest

Lori A. S. Snyder is co-inventor of UK patent GB1701450.7 (pending)/EU patent 18,154,222.6-1112 (pending). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.