Ophthalmia neonatorum — formative SAQs

SAQ 1 — The three-day-old with a profuse purulent eye (10 marks, 15 minutes)

A three-day-old term boy is referred from the postnatal ward with a 12-hour history of profuse, thick, yellow-green discharge from the right eye that reaccumulates within minutes of cleaning. Both eyelids are swollen and chemotic and the eye is intensely red. He was born by spontaneous vaginal delivery after an unbooked pregnancy with no documented antenatal sexually-transmitted-infection screening. [12]

a) What is the most likely diagnosis, and which feature makes it a sight-threatening emergency? State the onset window that supports it. (2 marks) [1]

b) Outline your immediate emergency management, including the specific drug, dose, route and the bedside measure that protects the cornea, before any culture result. (3 marks) [1]

c) The infant is clinically jaundiced. How does this change your drug choice, and why? Name the alternative agent. (2 marks) [1]

d) List the conjunctival swab investigations you would send, and explain why you would not delay treatment while awaiting them. (3 marks) [4] [11]

SAQ 2 — The ten-day-old with a sticky eye and a cough (10 marks, 15 minutes)

A ten-day-old infant presents with bilateral mucopurulent eye discharge for four days and, over the last two days, a repetitive staccato cough. The infant is afebrile, feeding adequately and not distressed, but the mother describes the cough as "spasms of tiny coughs." No maternal sexually-transmitted-infection screening was performed. [6]

a) What is the diagnosis, and what does the staccato cough signify? Give the onset window that supports the diagnosis. (2 marks) [6]

b) Give the definitive systemic treatment, including the drug, dose, route and duration, and explain why topical therapy alone is insufficient. (3 marks) [5]

c) Outline the maternal and partner management and the rationale for it, including the role of birth prophylaxis. (3 marks) [3]

d) State two complications to monitor for in the weeks following, and one counselling point regarding the treatment drug. (2 marks) [5] [7]