Neonatal Gonococcal Conjunctivitis: A Case Report
In the first three days, there was significant swelling. There was a flow of yellow purulent discharge, which worsened after exposure to sunlight (+). The patient was admitted to the hospital's pediatric department six days after birth. The child was delivered at 39 weeks via normal delivery. The mother had suffered from gonorrhea six months ago but did not receive formal treatment.
Examination on the 8th day revealed: Temperature 38.2°C, Heart Rate 120 beats/min, Respiratory Rate 40 breaths/min, Weight 3.3 kg, with clear consciousness. The reaction was good, and the baby cried loudly. The anterior fontanelle was flat, and both eyelids were red and swollen. There were large amounts of yellow purulent discharge. The conjunctiva showed hyperemia and swelling. Nasal cavity, external auditory canal secretions, oral cavity without white clots, neck soft, heart (-), lungs (-), abdomen (-), umbilicus dry with no abnormal findings (NS -).
Laboratory tests: Smear of one eye secretion showed Neisseria gonorrhoeae intracellularly. Outside detection found Gram-negative diplococci. Blood test results: Hb 210 g/L, RBC 6.0 x 10^12/L, WBC 10.4 x 10^9/L, N 0.70, L 0.30. Urinalysis was normal.
Treatment: Intravenous administration of 80 million units of sodium penicillin for 6 hours. Normal saline mixed with 800,000 units of sodium penicillin in 80 ml was used to flush the conjunctival sac every few minutes continuously for half an hour, then changed to every five minutes for another half-hour. For the next 6 hours, it was administered every half-hour. Then, it was changed to small doses every hour for 12 hours. In the last two hours, it was administered every 24 hours.
After 7 hours of treatment, the eyes stopped discharging purulent secretions, and the temperature normalized within 24 hours. Three days later, the swelling of the double eyelid subsided, eyes opened freely, and the cornea was clear.
The newborn contracted Neisseria gonorrhoeae through direct contact with the mother's vaginal secretions during childbirth. Indirect contact with contaminated towels, clothing, or appliances could also cause neonatal gonococcal conjunctivitis.
Neonatal gonococcal conjunctivitis is the most severe form of infectious eye disease. It is characterized by severe edema and hemorrhage of the eyelids and conjunctiva, with a large amount of purulent discharge. It tends to invade the cornea, causing ulcers, scars, necrosis, and even perforation, leading to blindness. Effective treatment should be administered promptly.
A single dose of antibiotics through intravenous drug therapy reaches the conjunctiva via blood circulation in very small amounts, unable to effectively kill Neisseria gonorrhoeae. Most of the bacteria can be flushed out by using normal saline to rinse the conjunctival sac. Local treatment with Green each hormone can improve bactericidal efficacy. Reports indicate that topical use of Green has fewer allergic reactions compared to intravenous drug use.
The authors suggest that due to the imperfect development of the immune system in the neonatal period, and since the disease occurs mostly within 2-3 days after birth, belonging to the early neonatal period, local allergic reactions with penicillin are less frequent than those received by adults.
Received on March 21, 1995.