Guide The NICU Through A Mothers Eye

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Conjunctivitis (Pink Eye) in Newborns

Health Tools. Our Neonatal Team Our multidisciplinary neonatal team delivers the compassion and expertise your baby needs. Nowhere else is the margin of error so incredibly small. Everything has to be perfect; there is no room for mistakes as these little lives hang on the line.

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NICU nurses treat these babies as if they were our very own, and when everything turns out well, rejoice and celebrate alongside the parents. Yet when the outcome is not what was wanted, even if it was out of our control, we too, feel sadness and grief. Just like everyone else, NICU nurses have good days and bad days themselves.

Good days of personal happiness, feeling elated and energetic. While other days we may feel tired, stressed, discouraged, or even burned out.

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There are the days we enjoy coming to work and making a difference and other days we would rather be on a different roller coaster It's important for you to know that we are not here for the great hours, the coffee breaks, or the money, but we are, and always will be here for your baby. There is great love and satisfaction in guiding you through the twists and turns, up steep hills and down the unpredictable drops of this intense roller coaster ride we call the NICU.

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When you finally arrive at your destination of discharge, we are there too, cheering you on with great pride. At the end of the day, nurses unlike parents get to leave the NICU behind and go back to a more predictable and somewhat calmer world at home.

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The blessings and sadness of the NICU still remain, but lying beneath the mental and physical exhaustion is the overwhelming feeling of satisfaction that comes along with being a NICU nurse, and really there is no greater job than this. These findings were believed to be due to an iris cyst, an extremely rare finding. Interestingly, the cyst spontaneously resoved over a few months. For comparison, this is the completely normal right eye of the same infant.

Note the lack of injection in the sclera, the normal greyish blue iris and the clear pupil. A red reflex was easily obtained in this eye.

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This is another newborn with unilateral conjunctival injection. On initial examination, the right pupil was about 2mm in diameter and the normal left pupil was mm. A red reflex was not present on the right side. This photo was taken after dilating drops were placed. Some dilation of the right pupil is noted, but it was not equal with the left, and still the retina could not be well seen.

The differential diagnosis includes tumor and vascular abnormalities. An ultrasound of the eye was done to evaluate this finding further. This is the same infant shown in the previous photo. Here the light from the ophthalmoscope is shined obliquely across the front of the eye. Without any special equipment, a red tinge described by the ophthalmologist as a lacy network of peripupillary vessels can be appreciated at the rim of the pupil.

When the other eye was evaluated in this way, no red color was seen. When gonococcal conjunctivitis occurs, it typically presents in the first few days of life with copius, purulent discharge in the eyes.

In this infant, the marked edema of the eyelids was the first symptom noted, but with just slight pressure on the lids, purulent material oozed out seen here. Unlike the typical "pink eye" conjuncitivitis that occurs in older children, gonococcal conjunctivitis is an ophthalmologic emergency. Because the bacteria can erode through an intact cornea, treatment is very aggressive and includes systemic intravenous antibiotics, frequent eye washes, and monitoring in a neonatal intensive care unit.

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Fortunately, this diagnosis is very uncommon in places where prophylactic antibiotic eye ointment is used at birth. This infant presented with hazy bilateral corneal opacities on the initial newborn exam.

Congenital glaucoma was the underlying cause. This infant has haziness of the central cornea visible without special equipment. On evaluation with an ophthalmoscope, red reflexes could not be seen due to this opacity. Although the opacity is central and could be mistaken for opacity of the lens, a view from a more oblique angle showed that the cloudiness extended over parts of the iris as well. In contrast to the previous photo, the opacities here occur behind the pupil, as the pupil is easily and clearly seen along its entire circumference.

Again, the opacity can be appreciated without any special equipment a good reminder to assess the eyes visually even if an ophthalmoscope is not readily available. A red light reflex could not be obtained. Congenital cataracts require early intervention to preserve sight, so immediate referral to a pediatric ophthalmologist is indicated.