N. gonorrhoeae infection in a newborn usually involves the eyes (ophthalmia neonatorum). Other sites of infection include scalp abscesses (often associated with fetal monitoring with scalp electrodes), vaginitis, and disseminated disease with bacteremia, arthritis, or meningitis. Transmission to the infant usually occurs during passage through the birth canal when mucous membranes come in contact with infected secretions.
Infection usually is present within the first 5 days of life and is characterized initially by a clear, watery discharge, which rapidly becomes purulent. There is marked conjunctival hyperemia and chemosis. Infection tends to be bilateral; however, one eye may be clinically worse than the other. Untreated infections can spread to the cornea (keratitis) and anterior chamber of the eye. This extension can result in corneal perforation and blindness.
Recommended treatment for isolated infection, such as ophthalmia neonatorum, is one intramuscular dose of ceftriaxone. Infants with gonococcal ophthalmia should receive eye irrigations with saline solution at frequent intervals before discharge. Topical antibiotic therapy alone is inadequate and is unnecessary when recommended systemic antimicrobial therapy is given. Infants with gonococcal ophthalmia should be hospitalized and evaluated for disseminated disease (sepsis, arthritis, meningitis). Disseminated disease should be treated with antimicrobial therapy (ceftriaxone or cefotaxime) for 7 days. Cefotaxime can be used in infants with hyperbilirubinemia. If documented, infants with meningitis should be treated for 10 to 14 days.
Tests for concomitant infection with C. trachomatis, congenital syphilis, and HIV should be performed. Results of the maternal test for hepatitis B surface antigen should be confirmed. Topical prophylaxis with silver nitrate, erythromycin, or tetracycline is recommended for all newborns for the prevention of gonococcal ophthalmia.
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C. trachomatis is the most common reportable sexually transmitted infection, with a high rate of infection among sexually active adolescents and young adults. Prevalence of the organism in pregnant women ranges from 6% to 12% and can be 40% in adolescents. Chlamydia can be transmitted from the genital tract of an infected mother to her newborn. Acquisition occurs in about 50% of infants born vaginally to infected mothers. Transmission also has been reported in some infants delivered by cesarean section with intact membranes. In infected infants, the risk of conjunctivitis is 25% to 50%, and the risk of pneumonia is 5% to 20%. The nasopharynx is the most commonly infected anatomic site.
Neonatal chlamydial conjunctivitis is characterized by ocular congestion, edema, and discharge developing 5 to 14 days to several weeks after birth and lasting for 1 to 2 weeks. Clinical manifestations vary from mild conjunctivitis to intense inflammation and swelling. Both eyes are almost always involved; however, one eye may appear to be more swollen and infected than the other. The cornea is rarely involved, and preauricular adenopathy is rare.
Pneumonia in a young infant can occur between 2 and 19 weeks of age and is characterized by an afebrile illness with a repetitive staccato cough, tachypnea, and rales. Wheezing is uncommon. Hyperinflation with diffuse infiltrates can be seen on chest radiograph. Nasal stuffiness and otitis media can occur.