Superficial neonatal infections involve the umbilicus, oral mucosa, eyes, or skin. Extent and signs of systemic illness influence treatment.
Omphalitis
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Omphalitis presents with redness or induration around the umbilicus or pus draining from it. Unclean handling or substances applied to the cord may initiate infection, which can progress to life-threatening systemic sepsis.
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Redness extending less than 1 cm into surrounding skin without signs of sepsis is treated with local antiseptic cleaning followed by 0.5% gentian violet four times daily until redness subsides.
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Redness extending beyond 1 cm or signs of sepsis indicate severe infection requiring systemic antibiotics in addition to local treatment.
Oral thrush
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White patchy lesions may occur on the oral mucosa and tongue of healthy newborns. Actual thrush lesions are difficult to remove and leave hemorrhagic points when removed.
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Apply local nystatin or clotrimazole four times daily after feeds.
Eye discharge and conjunctivitis
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Sticky eyes have mucoid discharge without inflammation and require cleaning with warm water.
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Conjunctivitis has purulent discharge with signs of inflammation and is treated with antibiotic instillation.
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Severe inflammation with pus or lid inflammation may result from gonococcal infection, which can cause blindness and requires systemic antibiotic therapy.
Cutaneous bacterial infections
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These usually present with pustules, but may appear as bullous impetigo or perifollicular lesions such as folliculitis.
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Staphylococcus aureus and β-hemolytic streptococci are the most implicated bacteria.
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Local treatment uses mupirocin and fusidic acid. If pustules are extensive, numbering more than 10, a course of oral antibiotics can be given.