Updated on  February 20, 2024
6 min read

Neonatal Conjunctivitis

11 sources cited
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Key Takeaways

  • Neonatal conjunctivitis (ophthalmia neonatorum) is a form of “pink eye” that occurs in newborns. It’s an eye infection that turns one or both of their eyes red.
  • Neonatal conjunctivitis is caused by bacteria, viruses, and infections that pass from the mother onto the child. Symptoms include redness, discharge from the eye, eyelid swelling, etc.
  • You can prevent neonatal conjunctivitis by getting treatment for STIs/STDs as well as using antibiotic treatment.
  • Various treatment options are also available to remove neonatal conjunctivitis before complications arise.

What is Neonatal Conjunctivitis (Ophthalmia Neonatorum)?

Neonatal conjunctivitis (ophthalmia neonatorum) occurs in newborns. It’s an infection that turns one or both of their eyes red.

Conjunctivitis is commonly known as “pink eye.” The conjunctiva is the transparent layer of tissue surrounding the whites of the eye. When it gets inflamed or irritated, it turns pink or red.


Neonatal conjunctivitis occurs within the first 28 days of life (the neonatal period). It is caused by a bacterial or viral pathogen acquired during birth. This means that the birth canal is infected.

How Common is Neonatal Conjunctivitis?

Globally, neonatal conjunctivitis occurs in 1 to 12 percent of all newborns. However, its prevalence varies widely according to:

  • Socio-economic conditions
  • Health education
  • Maternal healthcare
  • Type of prophylaxis (preventative treatment) used.

In developed countries, the rate of this condition is less than .5%, but it is much more common in low-income countries.

What Causes Neonatal Conjunctivitis?

Bacteria, viruses, and chemicals typically cause neonatal conjunctivitis. Historically, gonorrhea was considered the usual cause of neonatal conjunctivitis.

However, chlamydial infection is now more common. Common types of conjunctivitis include:

Chemical Conjunctivitis

Chemical conjunctivitis is caused by eye drops used to prevent gonococcal infection. They are commonly made of silver nitrate. In the United States, this method has been replaced by tetracycline or erythromycin ointment.

Chemical conjunctivitis usually appears 6 to 8 hours after the eye drops are administered. It usually disappears spontaneously after 24 to 96 hours.

Bacterial Conjunctivitis

Bacterial conjunctivitis is the most common cause of ophthalmia neonatorum. This occurs when bacteria gets transferred from the mother to the baby during birth. The most common type of bacterial conjunctivitis is chlamydial conjunctivitis.

Bacterial conjunctivitis

Gonococcal Conjunctivitis

Gonococcal conjunctivitis is the next most common bacterial conjunctivitis caused by Neisseria gonorrhoeae. Symptoms typically appear within 3-5 days after birth.

N. gonorrhoeae causes gonorrhea, a sexually transmitted infection (STI). Gonorrhea causes less than 1% of cases of neonatal conjunctivitis.

Other bacteria that cause neonatal conjunctivitis include:

  • Haemophilus species
  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Streptococcus viridans
  • Escherichia coli
  • Pseudomonas aeruginosa

Adenoviral Conjunctivitis

Adenoviral conjunctivitis is caused by viruses or infections. Herpes Simplex Virus (HSV) and adenovirus are the most common causes. Adenoviral conjunctivitis is extremely contagious, and caregivers should use extreme caution and keep their hands clean to prevent the virus from spreading to others.

viral conjunctivitis

Symptoms of Neonatal Conjunctivitis

Symptoms of neonatal conjunctivitis usually appear within one day to two weeks after birth.

Common symptoms include:

  • Redness in the eye
  • Mucopurulent or purulent discharge (liquid oozing from the eye)
  • Chemosis, or swelling of the conjunctiva
  • Symptoms present in both eyes

Neonatal conjunctivitis might also be asymptomatic, so practicing good prevention is essential. Neonatal conjunctivitis should not be confused with keratitis, the inflammation of the cornea.

If you think your child has neonatal conjunctivitis, talk to an ophthalmologist. They’ll be able to rule out keratitis and other eye infections.

How to Prevent Conjunctivitis in a Newborn

There are four strategies to prevent ophthalmia neonatorum:

1. Screen Pregnant Women for Genital Infection

All pregnant women should be screened for infections or sexually transmitted diseases (STDs) at their first prenatal visit. These include:

  • Gonorrhea
  • Herpes
  • Chlamydia

If they are infected, they should be treated before the baby is born.  

2. Prevent STDs/STIs Spreading from Mother to Child

If they are not tested during pregnancy, pregnant mothers should be tested at delivery or before taking the baby home. Mothers with STDs must also take measures to prevent neonatal conjunctivitis.

Babies born to women with untreated chlamydia at delivery have a 30-50% chance of developing ophthalmia neonatorum. Approximately 25% to 50% of infants exposed to C. trachomatis and Neisseria gonorrhea develop neonatal conjunctivitis without treatment.

Before giving birth, women with genital herpes should consult with their doctor about ways to reduce the chances of spreading the infection to their newborn. They can take acyclovir to prevent an outbreak that could spread to the child.

3. Provide Topical or Systemic Treatment at birth

State laws require most hospitals to put eyedrops or ointment in a newborn’s eyes as an ocular prophylaxis. They’ll typically administer topical antibiotic ointments like:

  • Erythromycin
  • Tetracycline
  • Azithromycin
  • Chloramphenicol

Early Diagnosis and Treatment

All infants should receive ocular prophylaxis at birth to prevent gonococcal ophthalmia. If conjunctivitis is suspected, the newborn should be treated immediately.

Early diagnosis of neonatal conjunctivitis is essential because the infection can progress quickly. Even if the exact cause is undetermined at the onset of symptoms, patients should begin treatment immediately to prevent complications.

An individual with a cold or virus should avoid contact with a newborn infant under three months. This is because cold and flu viruses may cause neonatal conjunctivitis.

How is Neonatal Conjunctivitis Diagnosed?

If your child has neonatal conjunctivitis, a doctor or ophthalmologist will perform tests to determine the cause. Standard tests include:

  • Taking swabs for culture
  • PCR test
  • gram test

If a bacterial infection is suspected, a doctor may use a gram stain to distinguish the type of bacteria that caused the illness to provide appropriate care.

How Do You Treat Conjunctivitis in Babies?

Common treatments for conjunctivitis in babies include:

  • Frequent irrigation with sterile isotonic saline, lubrication, or artificial tears
  • Avoiding eye patching
  • Topical erythromycin
  • Antibiotic drops or ointments
  • Antivirals such as acyclovir
  • Intravenous (IV) antibiotics such as ceftriaxone
  • A warm compress to the eye
  • Isolation of a patient to prevent contagion spread

Neonatal Conjunctivitis Prognosis

The prognosis for neonatal conjunctivitis is generally good, especially if early diagnosis and treatment are undergone. Details on the outlook include:

  • Chemical infections. Full recovery is expected spontaneously after 24 to 96 hours
  • Chlamydial infections. Approximately 80% of neonates fully recover after one round of treatment; further treatment may be required in other cases
  • Other bacterial infections. These infections usually respond to appropriate treatment; however, missed infections can cause sight impairment or even death
  • Viral Infections. Vision impairment is likely, and results may be fatal

Dangers and Complications

The most common and dangerous complications relate to gonococcal conjunctivitis. These may include:

  • Conjunctival scarring
  • Keratitis
  • Corneal pannus
  • Permanent visual impairment
  • Other rare side-effects of treatments

If left untreated, ophthalmia neonatorum can lead to severe complications, including:

  • Ulceration
  • Perforation of the cornea
  • Blindness

The chlamydial infection can also cause pneumonia in newborns.

Rare Side Effects

Most other cases of conjunctivitis are not dangerous. However, rare side effects may occur, including:

  • Systemic infection (chlamydial pneumonia, disseminated herpes simplex, etc.)
  • Corneal ulceration
  • Pseudomonas 

Pseudomonas is very rare, but it could cause keratitis and, ultimately, death.

Updated on  February 20, 2024
11 sources cited
Updated on  February 20, 2024
  1. Castro O., and Mendez, M. “Ophthalmia Neonatorum.” Treasure Island (FL): StatPearls Publishing, 2021.
  2. Conjunctivitis.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 2019.
  3. Do You Have Keratitis vs. Conjunctivitis? Here’s How to Tell.” U.S. News & World Report, U.S. News & World Report.
  4. Makker et al. “Neonatal Conjunctivitis.” Treasure Island (FL): StatPearls Publishing, 2023.
  5. Kapoor et al. “Interventions for preventing ophthalmia neonatorum.” The Cochrane Database of Systematic Reviews, 2016.
  6. Matejcek, A., and Goldman, R. “Treatment and prevention of ophthalmia neonatorum.” Canadian family physician Medecin de famille canadien 2013.
  7. McCourt, E. “Neonatal Conjunctivitis (Ophthalmia Neonatorum).” 2019.
  8. Moore et al. “Preventing ophthalmia neonatorum.” The Canadian journal of infectious diseases & medical microbiology, 2015.
  9. Neonatal Conjunctivitis.” EyeWiki, American Academy of Opthalmology, 2020.
  10. Ophthalmia Neonatorum.” College of Optometrists – Professional Body for Optometrists.
  11. Preventing Conjunctivitis (Pinkeye) in Your Newborn.” Preventing Conjunctivitis (Pinkeye) in Your Newborn – Caring for Kids.
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