Neonatal haemorrhagic conjunctivitis: a specific sign of chlamydial infection.

OBJECTIVE To review the bacteriological causes and clinical features of acute neonatal conjunctivitis in a local paediatric centre. DESIGN Retrospective review. SETTING Paediatric unit of a regional hospital, Hong Kong. PATIENTS All neonates who presented to Tuen Mun Hospital from 1 January 1996 to 31 December 2002 with persistent eye discharge and a positive eye swab culture. MAIN OUTCOME MEASURES Clinical features of neonates with chlamydial and non-chlamydial conjunctivitis. RESULTS Of 90 neonates with positive eye swab or conjunctival scraping cultures, Chlamydia trachomatis was the second most common (n=19, 21%) cause of acute neonatal conjunctivitis after Staphylococcus aureus (n=32, 36%). All of the neonates with chlamydial conjunctivitis were delivered vaginally: two of them had concomitant chlamydial pneumonia. Neisseria gonorrhoeae conjunctivitis was rare (n=1, 1%). None of the mothers of neonates with Chlamydia had any history of sexually transmitted disease. The timing of presentation, gestational age, birth weight, and sex of the neonates did not suggest a risk of chlamydial infection. Nonetheless haemorrhagic eye discharge had a specificity of 100% and positive predictive value of 100% for chlamydial infection. There were no adverse ophthalmological consequences or complications of pyloric stenosis in any neonate following treatment with oral erythromycin. CONCLUSIONS Haemorrhagic eye discharge is a highly specific sign of neonatal chlamydial conjunctivitis. Early and prompt treatment with oral erythromycin is safe and effective.