Ophthalmia neonatorum — branching viva

Branching viva from a three-day-old with profuse purulent discharge and lid oedema, through the recognition of gonococcal ophthalmia neonatorum, the emergency systemic treatment and the ceftriaxone-versus-cefotaxime decision, with a pivot to a ten-day-old with mucopurulent discharge and a staccato cough testing chlamydial ophthalmia, its pneumonia and systemic erythromycin, and a final probe on neonatal HSV keratoconjunctivitis and birth prophylaxis.

branching clinical structured oral2 min readVerification in progress

Prompt

You are the paediatric registrar on the postnatal ward. The examiner asks you to work through a three-day-old referred with profuse purulent eye discharge and marked lid oedema born to a mother with no documented sexually-transmitted-infection screening, and then a ten-day-old with a sticky eye and a staccato cough. A final stem covers a neonate with periocular vesicles. Information is released in stages.

Opening — the three-day-old with a profuse purulent eye

Examiner: A three-day-old term infant is referred from the postnatal ward with profuse thick yellow-green discharge from the right eye and marked bilateral lid oedema. He was born vaginally to a mother with no documented sexually-transmitted-infection screening. Talk me through your immediate thoughts and actions. [12]

Candidate should cover: the diagnosis of gonococcal ophthalmia neonatorum based on the day 2 to 5 onset window, the profuse purulent discharge and lid oedema; recognition that it is sight-threatening because Neisseria gonorrhoeae can ulcerate and perforate the cornea within hours; and immediate management — admit, swab, begin frequent saline irrigation and give single-dose ceftriaxone before culture returns. [1]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References9Show ledger

[1]Castro Ochoa KJ; Gurnani B Ophthalmia Neonatorum (Neonatal Conjunctivitis). StatPearls, 2026.PMID 31855399
[3]Moore DL; MacDonald NE; Canadian Paediatric Society Preventing ophthalmia neonatorum. Paediatr Child Health, 2015.PMID 25838784
[4]Curry SJ; Krist AH; Owens DK; et al Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: US Preventive Services Task Force Reaffirmation Recommendation Statement. JAMA, 2019.PMID 30694327
[5]Zikic A; Schunemann H; Wi T; et al Treatment of Neonatal Chlamydial Conjunctivitis: A Systematic Review and Meta-analysis. J Pediatric Infect Dis Soc, 2018.PMID 30007329
[6]Zar HJ Neonatal chlamydial infections: prevention and treatment. Paediatr Drugs, 2005.PMID 15871630
[7]Pinninti SG; Kimberlin DW Neonatal herpes simplex virus infections. Semin Perinatol, 2018.PMID 29544668
[9]Isenberg SJ; Apt L; Yoshimori R; et al Povidone-iodine for ophthalmia neonatorum prophylaxis. Am J Ophthalmol, 1994.PMID 7977595
[11]Belagal P Current alternative therapies for treating drug-resistant Neisseria gonorrhoeae causing ophthalmia neonatorum. Future Microbiol, 2024.PMID 38512111
[12]Tan AK Ophthalmia Neonatorum. N Engl J Med, 2019.PMID 30625059