Which organism is the most common bacterial cause of acute purulent conjunctivitis in neonates if prophylaxis with silver nitrate or antibiotics is not given?

Explanation

## Neonatal Bacterial Conjunctivitis **Key Point:** Neisseria gonorrhoeae is the most common cause of acute purulent conjunctivitis in neonates born to untreated mothers, presenting within 2–5 days of birth with copious purulent discharge and potential corneal involvement. **High-Yield:** Gonococcal ophthalmia neonatorum (GON) is a medical emergency because it can rapidly progress to corneal scarring, vascularization, and blindness if untreated. This is why neonatal prophylaxis (silver nitrate 1%, tetracycline ointment, or erythromycin ointment) is mandatory in all newborns. **Clinical Pearl:** The hallmark of GON is severe chemosis, eyelid edema, and thick purulent discharge appearing 2–5 days after birth. Gram stain shows gram-negative intracellular diplococci within polymorphonuclear leukocytes. ### Prophylaxis and Treatment - **Prophylaxis:** Silver nitrate 1% drops, tetracycline 1% ointment, or erythromycin 0.5% ointment at birth - **Treatment of GON:** Ceftriaxone 50 mg/kg IV/IM daily (or cefotaxime) for 7 days, plus topical antibiotics - **Maternal treatment:** Essential to prevent neonatal infection **Mnemonic:** **GONORRHEA** — Remember: **G**onorrhea is the **G**reatest threat to neonatal vision without prophylaxis.