Variability in the Evaluation and Treatment of Healthy Neonates With Uncomplicated Conjunctivitis

To explore the current state of diagnosis and management of neonatal conjunctivitis.

Cosmos, an EHR-based, de-identified data set including more than 200 million patients, was used for this study. Neonates born between January 1, 2016 and December 31, 2022, discharged from the hospital by day 3 of life, and with an ambulatory visit within the first 4 weeks of life associated with a new diagnosis of neonatal conjunctivitis (SNOMED) or conjunctivitis (ICD-10 H10.*) were included. Cosmos slicer/dicer software was used to extract demographic, diagnostic, etiologic, and therapeutic data.

A total of 1,870 of 7,325,276 (0.0255%) neonates with a hospital stay of 3 days or less met criteria for inclusion: 96.5% were from the United States, 16.2% were admitted to the hospital, and bacterial cultures were obtained from 21.3%. Congenital lacrimal duct stenosis was causative in 2.7% of patients. Important infectious agents included staphylococcal, streptococcal, or enterococcal species (2.5%), Neisseria gonorrhoeae (1.6%), and Chlamydia trachomatis (0.6%). No herpesviral or Pseudomonas infections were identified. Antimicrobial agents were prescribed to 93.7% of patients and given ophthalmically (79.5%), orally (11.4%), and parenterally (7.7%).

The evaluation and management of neonatal conjunctivitis within United States ambulatory settings are highly variable. Diagnostic studies are underused, resulting in limited etiologic data and a lack of susceptibility-guided treatment. [.