Differential Diagnosis for a 2-Day-Old Newborn with Bilateral Eye Discharge
- Single Most Likely Diagnosis
- B) Chemical conjunctivitis: This is the most likely diagnosis given the context that the newborn was delivered at home and has not yet been examined by a physician. Chemical conjunctivitis can occur due to the use of prophylactic eye drops or ointment (typically silver nitrate or erythromycin) immediately after birth to prevent gonococcal ophthalmia neonatorum. The symptoms of chemical conjunctivitis, such as eye discharge and swelling, usually appear within the first 24-48 hours of life, fitting the timeline of this case.
- Other Likely Diagnoses
- C) Chlamydial conjunctivitis: This is another possible diagnosis, as Chlamydia trachomatis can be transmitted from the mother to the newborn during delivery, leading to inclusion conjunctivitis. However, symptoms typically appear 5-14 days after birth, making it less likely in this 2-day-old newborn.
- D) Gonococcal conjunctivitis: Although less common due to prenatal screening and treatment of gonorrhea in pregnant women, gonococcal conjunctivitis is a serious condition that can cause severe eye discharge and swelling. It is typically seen within the first 5 days of life.
- Do Not Miss Diagnoses
- D) Gonococcal conjunctivitis: Despite being less likely due to modern prenatal care, gonococcal conjunctivitis is a critical diagnosis not to miss because it can lead to corneal perforation and blindness if not promptly treated.
- Rare Diagnoses
- A) Allergic conjunctivitis: This is unlikely in a 2-day-old newborn, as allergic reactions typically require prior exposure to allergens and are rare in the neonatal period.
- E) Mucocutaneous lymph node syndrome (Kawasaki disease): Kawasaki disease is extremely rare in newborns and does not typically present with isolated eye discharge and swelling as its primary symptoms. It involves fever, rash, swelling of hands and feet, conjunctivitis, and other systemic signs.