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M. G. Shipley, N. Khuddus, M. A. Saxonhouse; Clinical Significance of Ocular Discharge in the Premature Neonate. Invest. Ophthalmol. Vis. Sci. 2008;49(13):514.
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Ocular discharge in the premature neonate is a commonly encountered problem in the neonatal intensive care unit (NICU), but there is little consensus among neonatologists and ophthalmologists on how to adequately manage and treat it. Certain pathogens, such as pseudomonas aeruginosa, when implicated as the cause of neonatal conjunctivitis, have been reported to result in meningitis and sepsis in premature neonates. The question then arises regarding whether the presence of ocular discharge warrants blood cultures and the initiation of intravenous antibiotics to prevent rare but significant complications.The goals of the study were to analyze all bacterial eye cultures in neonates < 37 weeks gestational age in the NICU over a two year time period, and to then analyze the blood culture results (performed one week prior and/or one week after the eye culture) from those neonates who had an eye culture. Results of this study would then be applied to create a clinical protocol for the management of ocular discharge in the premature neonate at our institution.
A retrospective cohort analysis was performed for all neonates < 37 weeks gestational age admitted to the NICU at Shands Hospital at the University of Florida between January 1, 2005 and December 31, 2006.
There were 974 neonates < 37 weeks gestational age admitted to the NICU. An eye culture was performed for ocular discharge in 99 of the neonates. Of these, 58/99 (59%) also had a blood culture obtained within the specified two-week period of time. The same organism grew from both the eye and blood cultures in 6/58 (10%) of these neonates. Specifically, 4/58 (6.9%) grew gram positive organisms (3 Staphylococcus aureus and 1 Staphylococcus epidermidis) and 2/58 (3.5%) grew gram negative organisms (1 Enterobacter cloacae and 1 Enterobacter aerogenes).
From this study, we conclude that given the serious implications of gram negative sepsis in the premature neonate and the frequency with which the eye and blood cultures grew the same gram negative organism, it is justified to obtain a blood culture when the eye culture reveals a gram negative species, especially if the neonate has signs of sepsis when an eye culture is obtained.
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