67 Is Ophthalmia Neonatorum associated with Invasive Bacterial Infection? A single centre retrospective study

Abstract

Abstract Background The immature immune system of neonates puts them at an increased risk of invasive bacterial infections (IBI). Ocular complications due to ophthalmia neonatorum (ON) are well described, unlike the association with IBI for which only case reports of ON with bacteremia and meningitis are documented. The risk of IBI in neonates with ophthalmia neonatorum (ON) is poorly known and part of the issue is the lack of clinical data. Objectives Our objective was to document the association of ON with IBI. Design/Methods This is a retrospective observational chart review of all afebrile neonates who presented to a single emergency department (ED) between January 2018 and December 2019 and were diagnosed with ON. Newborns with craniofacial malformations and premature infants were excluded. The primary outcome was IBI as defined by growth of any bacterial pathogen in the blood or cerebrospinal fluid. Perinatal risk factors, ED visit details (symptoms on presentation, management and treatment plan) as well as complications (ocular morbidity, death and unscheduled return visits to the ED) were collected. Data were analyzed using descriptive statistics. Results Fifty-two neonates were included in this retrospective review. There were no case of IBI associated with ON (0%, 95%CI 0-6.9%). Six ocular bacterial infections were identified, one of which was C trachomatis. Although there was no IBI, ocular complications, death or unscheduled return visits to the ED, there was a wide variation in physician management of ON. Physicians performed at least para-clinical investigation in 49% (95%CI: 34-62%) of neonates, prescribed antibiotics to 87% (95% CI: 74-94%) and involved specialists in 39% (95%CI: 27-52%) of cases. Most neonates were discharged home (92%; 95%CI: 81-98%) and three neonates (6%; 95%CI: 1-16%) were admitted to the hospital following their ED visit. Conclusion ED presentations of afebrile neonates with ON are associated with a low risk of IBI. A better understanding of the current practice variation is needed to inform clinical guidelines for the management of term neonates with ON presenting to the ED.