Should Your Newborn Get Prophylactic Eye Antibiotics at Birth?

baby_eyesAs doctors, we have a hard time letting go of traditions, ways of doing things, standards of care, even long after they make no sense. I’ve been advocating for years that we abandon the newborn and infant Hepatitis B series of vaccines when birth mom does not have Hepatitis B. That recommendation was from 20 years ago, when there were more babies being born to mom’s whose Hepatitis B status was unknown. The vaccine has a dangerous amount of aluminum for a child that small, and no benefit in this situation. To make maters worse it is not even giving lasting immunity when given this young.

The other newborn intervention, that goes back to the 1800’s, is the eye ointment in the newborn’s eye. This was traditionally done to prevent gonococcal eye infections for babies born to mom’s with gonorrhea. It was later justified as preventing neonatal syphilis infections of the eyes then more recently touted as preventing Chlamydia eye infections. The thing is, I haven’t had a case of a mom with gonorrhea or syphilis in over a decade, and the Obstetric providers always check mom’s for these infections anyway. If a mom had any of these infections, we would be treating with much more than eye ointment anyway. The erythromycin used in hospitals today does NOT cure a Chlamydia eye infection. The Canadian Paediatric Society has issued a policy statement “Preventing ophthalmia neonatorum” that is so clear

I provide it here:

“The use of silver nitrate as prophylaxis for neonatal ophthalmia was instituted in the late 1800s to prevent the devastating effects of neonatal ocular infection with Neisseria gonorrhea. At that time – during the pre antibiotic era – many countries made such prophylaxis mandatory by law. Today, neonatal gonococcal ophthalmia is rare in Canada, but ocular prophylaxis for this condition remains mandatory in some provinces/territories. Silver nitrate drops are no longer available and erythromycin, the only ophthalmic antibiotic eye ointment currently available for use in newborns, is of questionable efficacy. Ocular prophylaxis is not effective in preventing chlamydial conjunctivitis. Applying medication to the eyes of newborns may result in mild eye irritation and has been perceived by some parents as interfering with mother-infant bonding. Physicians caring for newborns should advocate for rescinding mandatory ocular prophylaxis laws. More effective means of preventing ophthalmia neonatorum include screening all pregnant women for gonorrhea and chlamydia infection, and treatment and follow-up of those found to be infected. Mothers who were not screened should be tested at delivery. Infants of mothers with untreated gonococcal infection at delivery should receive ceftriaxone. Infants exposed to chlamydia at delivery should be followed closely for signs of infection.”

 

You can read this statement in full here…

Dr. Paul

 

 

One comment

  • Janay

    This was something my husband and I decided against for both of our children. I was floored and offended that after multiple std screenings i received during my pregnancy that a NICU doctor was disappointed that we decided against the drops and Hep B. But I knew that there was risk.

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