Ophthalmia neonatorum prophylaxis in Vermont.

Vermont birth certificates and hospital medical charts for 1979 were reviewed to determine whether infants born at home or in hospitals had documentation of prophylaxis against gonococcal ophthalmia neonatorum. Of the 139 home births recorded in 1979, 78 infants (54.0 percent) received no prophylaxis, compared with 97 (1.4 percent) of 7,156 infants born in hospitals (P less than 0.0001). Ophthalmic medications that have not been recommended for use for neonatal prophylaxis were being used in two hospitals in the State. A followup review of 7,668 Vermont birth certificates for 1980 indicated that hospital practices improved in that year, after the hospitals received a reminder on proper prophylactic procedures from the Vermont Department of Health.     

Ophthalmia neonatorum

Ophthalmia neonatorum is defined as any conjunctivitis with discharge from the eyes during the first 28 days of life. Its etiology may be gonococcal or nongonococcal, Chlamydia trachomatis being the most important cause in the latter group. The risks of gonococcal and chlamydial ophthalmia in infants born to infected mothers may be up to 30% and 50%, respectively. Gonococcal ophthalmia, if untreated, may progress rapidly to corneal ulceration, perforation, and eventually blindness. Chlamydial ophthalmia is generally milder. Ophthalmia neonatorum can be prevented by: 1) the parents' avoidance of risky sexual behavior that could lead to sexually transmitted infections; 2) routine screening for chlamydia and gonococcal infections in antenatal clinics followed by appropriate treatment; and 3) disinfection of the infant's conjunctivae at birth by: a) use of 1% aqueous silver nitrate solution into each conjunctival sac; b) instillation of benzyl penicillin solution into the infant's eyes; or c) use of tetracycline 1% or erythromycin 0.5% eye ointment. The safety and efficacy of povidone-iodine ophthalmic solution to prevent ophthalmia neonatorum was evaluated by enrolling 3117 infants born at the Presbyterian Church Hospital in Kikuyu, Kenya, from March 1991 to August 1993. The infants received one of the ophthalmic preparations: a drop of 1% silver nitrate ophthalmic solution or a l cm strip of 0.5% erythromycin ophthalmic ointment, or a drop of 2.5% povidone-iodine solution. Povidone-iodine was significantly more effective than silver nitrate and erythromycin in preventing ophthalmia neonatorum overall, and especially in preventing chlamydia ophthalmia. The incidence of N. gonorrhea and Staphylococcus aureus infections was, however, similar in the three groups. Povidone-iodine deserves serious consideration in prophylaxis against ophthalmia neonatorum in developing countries because of its efficacy, low cost, and easy availability.     

Ophthalmia neonatorum in a semi-rural African community

The incidence and aetiology of ophthalmia neonatorum have been estimated over a 7-month period in Franceville, a semi-rural community in south-eastern Gabon. Chlamydia trachomatis was the most frequently observed pathogen, being isolated from 17 babies (2.7% of births), and Neisseria gonorrhoeae was recovered from 12 (1.6% of births). 5 of 17 cases of chlamydial conjunctivitis were in infants less than 5 d old as opposed to 9 in the typical 5 to 10-days-old group. As expected, most cases of gonococcal ophthalmia neonatorum occurred in the first 5 d of life with cases in older infants often not accompanied by a granulocytic response. Chlamydial conjunctivitis was usually unilateral whereas other cases were most frequently bilateral.     

Asphyxia neonatorum

Various biochemical and structural changes affecting the newborn's wellbeing develop as a result of perinatal asphyxia. Central nervous system abnormalities are frequent complications with high mortality and morbidity. Cardiac compromise may lead to dysrhythmias and cardiogenic shock. Coagulopathy in the form of disseminated intravascular coagulation or massive pulmonary hemorrhage are potentially lethal complications. Necrotizing enterocolitis, acute renal failure, and endocrine problems affecting fluid electrolyte balance are likely to occur. Even the adrenal glands and pancreas are vulnerable to perinatal oxygen deprivation. The best form of management appears to be anticipation, early identification, and prevention of potential obstetrical-neonatal problems. Every effort should be made to carry out effective resuscitation measures on the depressed infant at the time of delivery.     

电光性眼炎的治疗与预防

电光性眼炎是较为常见的眼科急诊,是由于眼部吸收一定能量的紫外线照射后所造成的损害.它多发生在电焊操作或室内紫外线消毒等紫外线辐射场所.由于一些操作人员的防护意识薄弱,防护设施不全,造成电光性眼炎的发病率居高不下.虽然短期内对人体造成的危害不大,但是反复多次发生可引起慢性眼睑炎、结膜炎、胬肉形成或角膜变性,影响视力[1].