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In follow up per Dr. Stephanie’s blog, Dr. Ramos in Jamaica shares the following information:

Our recommend treatment for Ophthalmia Neonatorum or Neonatal Conjuctivitis does not differ from what is recommended and practiced elsewhere including many Pediatric hospitals
in North America.

Providing that the suspected etiology is infectious, then “triple antibiotic therapy” is
recommended. This consists of:

Topical: Tetracycline
Eye Ointment 1% for 7 days
Oral: Erythromycin,
50mg/kg/day (divided q 6-8 h) for 2-3 weeks.
Paraenteral: Ceftriaxone
50m/kg/ single dose (maximum dose 125mg).

Neonates treated as outpatients should be reviewed within 2 weeks.

Based on my experience (over 10 years) using this “triple antibiotic therapy”, the vast majority of cases (>95%) will resolve.

We do not routinely recommend admission, unless there is an indication for it,

– Signs of systemic involvement (hyper, hypo or unstable body temperature, vomiting, coughing, sick looking baby, etc)
– Severe ocular signs (risk for intraocular complications)
– Concerns about treatment compliance or proper follow up.

If the baby is suspected to have a systemic sepsis in addition to the above outlined treatment regimen, we recommend a combination of Penicillin/ Aminoglycoside for at least 7 days or
until cultures reports are available.

It is to be remembered that cohorts differs from country to country, even from state to
state; therefore we must be aware of this when we approach a population of a different background than the one we are used to attend. Causative agents prevalences, popular practices, and socio-economic status all might also influence the way we approach these conditions.
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Yesterday we went to Port Antonio Hospital. This hospital was in Portland Parish, about a 2 hour drive through winding, hilly, jungle roads from our hotel. When we arrived (thanks to our very polite ride and hospital administrator, Mr. Campbell), we were warmly welcomed and put to work. We tried to start in the Peds ward, though the docs had already rounded for the day, so we went to the outpatient clinic.
In the Jamaica, Pediatrics is considered a subspecialty so we had a lot of patients that were referred to us from general practitioners. Again, we saw lots of rashes, URI’s, and scalp infections. We also saw two patients that we felt needed referral to ENT. One was a 2 year old male with language delay likely secondary to his tongue tie that was never corrected, and one 3 year old female with significant tonsillar hypertrophy and obstructive sleep apnea. Luckily (after a few phone calls and some very helpful nurses) we found out that there was an ENT clinic in Kingston at Bustamonte Children’s Hospital every Monday – in luck! We filled out referral forms and the parent’s seemed happy that something was hopefully going to be done.
After the Clinic and a quick lunch (we’re getting really good at making English Muffin sandwiches at the breakfast bar and stowing them), we went to the A&E to help out. We saw a mixture of patients, but a few stood out. We saw a 5 day old male that had some eye discharge, his eye looked fine and just had some drainage dried on his face. We thought this was maybe some lacrimal duct stenosis that was very normal, or maybe a very superficial infection, regardless our plan was some warm compresses and antibiotic eye drops. Though when we ran this by the attending doc, he said that he would admit this patient for 3 days of IV ceftriaxone, and erythromycin, tetracycline and neomycin eye drops. He could tell I looked surprised, and I said that that wasn’t standard practice in the states, and Ceftriaxone isn’t approved for a baby his age. At first he acknowledged my plan, but in the end he wanted to be “safe, rather than sorry” and admitted the patient. I was glad he entertained my input for a bit, but in the end it was his decision. Any thoughts about this from other docs that have been here and treated Opthalmia Neonatorum – they do get “eyes and thighs” in the deliver room.
Another patient we saw was a teenage girl with syncope, and after a good H&P we felt that this was orthostatic changes due to dehydration and she probably just needed some fluids. We told the nurse that we wanted to give her some fluids, and she handed me a glove (for a tourniquet) a cotton ball soaked in alcohol, and an IV cannula (one very different from the IV’s in the sates). Stephanie searched for a vein while i primed the tubes, and thankfully Stephanie got the IV in one try and we made it work! While this may seem like a small feat, we are so spoiled with our awesome nurses at Akron Children’s, we were both holding our breath!
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Yesterday we went to the Annotto Bay Health Center, an outpatient clinic in St. Mary’s Parish that is peacefully located on the water. Although the staff did not know we were coming, they were very welcoming and we knew we would be of use as there were rows of Moms and Children already lined up. Again, we saw a mix of URIs, rashes, Tinea, and constipation, but there was one patient that made us both skip a heartbeat, if only for a minute.

A mom was sent over to us with her 3 month baby from the nurse. She was quiet, though polite. She said that after her baby was born, he had to be admitted for a few days because he was breathing fast. The breathing was improved, though mom reports that he had a chest x-ray and EKG that per mom “showed that one side of his heart was bigger than the other” – cue Oh Crap! She was referred for an echocardiogram, though she could not afford it, and was subsequently referred to a cardiologist in Kingston that had an available appointment in September (7 months from now!). Upon further history, the baby was doing well, feeding and thriving (with occasional sweats), no pallor or cyanosis, and developmentally appropriate. His exam did reveal a very soft mid-systolic murmur at the apex and LLSB, though no signs of heart failure. Our portable pulse ox (Thank God and Dr. Gunkleman from Akron) showed sats of 96%. We were reassured by our findings and planned to look up the Xray and EKG tomorrow when we go to the hospital that the tests were performed. Our thoughts were that this baby was probably fine and maybe had a small VSD, and his EKG probably was just RVH (cue Dr. Bockoven, “RVH in a newborn is normal!” mantra). We told mom that we would check on all this and for her to follow up with us in 1-2 weeks, and to keep her appointment with cardiology in September. In the end we were much more comfortable, but what a scary chief complaint!!

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