ON is treatable in all of its forms, including ON from gonorrhea, as long as antibiotic treatment is started immediately. Erythromycin eye ointment can be reasonably declined if pregnant people are screened negative during the pregnancy for gonorrhea, if they are in a monogamous relationship with an uninfected partner, and if they are able to get immediate medical care should the newborn develop pus-containing pink eye.
Today, laws in many U. Given the fact that other options can be used to safely prevent and treat newborn eye infections, the mandatory nature of these erythromycin state laws should be re-evaluated. For parents: Take this article to an appointment and discuss it with your care provider!
Here are some questions to ask your provider that can help you make an informed decision about whether or not to use erythromycin eye ointment after birth. For providers: Where do we take this from here? There is an inherent tug-of-war between policy measures intended to protect the vulnerable members of a population and health care consumers who want their care individualized.
Based on our literature review, individualized care can be offered in place of mandatory eye ointment. The following questions are intended to help guide your discussion with clients and enhance the informed consent process around the use of erythromycin eye ointment prophylaxis. We would like to extend our gratitude to our expert clinician reviewers for their valuable feedback and critique of the version of this article before publication: Shannon J.
We would also like to thank Cristen Pascucci for her medical editing assistance. Join others who also want to help bring evidence-based care to their local community. Don't miss an episode! Subscribe to our podcast: iTunes Stitcher On today's podcast, we're going to talk with Ihotu Ali, MPH, who is writing about research on the effects of racism on pregnancy and birth outcomes.
Rebecca Dekker. PhD, RN. What is the history of using erythromycin eye ointment for newborns? What causes ophthalmia neonatorum ON? Can a baby get ON after a Cesarean? Which is a better strategy: Worrying about sexually transmitted infections during pregnancy or after birth?
How do you know if a mother is at risk for chlamydia or gonorrhea? As you can see in the table below, some countries use ON prophylaxis, while others have stopped this practice: State law in most U. What is the evidence for erythromycin prophylaxis to prevent newborn pink eye?
Does erythromycin prevent ON from other bacteria, such as staph? Are bacteria becoming resistant to erythromycin? If chemical pink eye is mistaken for bacterial pink eye, it could lead to treatment with more antibiotics while waiting for culture test results. Blurred vision could potentially interfere with bonding by disrupting early eye gazing between the newborn and parents Personal correspondence, Brazelton Institute, ; Bruschweiler-Stern, Screening and treatment of sexually transmitted infections during pregnancy One option is for the mother to be screened for sexually transmitted infections during pregnancy and receive antibiotic treatment, along with her sexual partner s , if needed.
They propose a screening and treatment strategy as an alternative to required prophylaxis that includes these recommendations: Screen all pregnant people for gonorrhea and chlamydia at their first prenatal visit. Positive test results require treatment with antibiotics during pregnancy and a re-test in the third trimester or, failing that, at the time of birth with the most rapid tests available ; partners should also be treated.
Negative test results require repeat screening in the third trimester or at the time of birth if the mother was at high risk of getting the infection during the pregnancy. If the mother tests positive for gonorrhea at the time of birth, then the newborn should be treated with injectable antibiotics without waiting for test results and should be further evaluated if unwell in any way.
This recommendation includes babies born by Cesarean. If the mother tests positive for chlamydia at the time of birth, then the newborn should be closely watched for symptoms of pink eye and treated only if the infection occurs. Another option is to wait and see if a newborn develops ON.
Another option is Povidone-iodine Povidone-iodine eye drops are becoming popular in some countries because they are less expensive than erythromycin. Another option is colostrum, or the first breast milk after the birth.
The bottom line Newborns receive erythromycin eye ointment after birth to prevent pink eye in the first month of life, also called ophthalmia neonatorum ON. Action Steps For parents: Take this article to an appointment and discuss it with your care provider!
Can we go over my prenatal screening history and discuss my test results for infectious diseases? Can we discuss my personal risk status for infection with chlamydia and gonorrhea? What will happen if I decide to refuse the erythromycin eye ointment?
What is their screening status? Have they been screened for gonorrhea and chlamydia during the current pregnancy or at the time of birth with a rapid test, if available? If the test was positive, were they treated with antibiotics along with their partner s and re-tested? If the test was negative but the mother is at high-risk for sexually transmitted infections, were they re-tested in the third trimester or at the time of birth?
What is their risk status? Do they claim to be in a monogamous relationship or have multiple sexual partners? How old are they? Women under 25 years of age are more at risk for gonorrhea and chlamydia. Do they live or travel to a place where the rate of gonorrhea or chlamydia is high? Did they give birth vaginally or by Cesarean?
If the mother gave birth by Cesarean, were her membranes intact at the time of the surgery? If the baby develops pus-containing pink eye, will they receive timely medical care? Have they been advised to watch for signs of pus-containing pink eye and bring the infant in for medical care immediately if it occurs? Lack of adequate prenatal care, insurance, or permanent housing could be an indication that access to medical care may be a barrier should the infant require treatment for ON.
References: American Academy of Pediatrics In: Kimberlin, D. Amini, E. A five-year study in Iran of ophthalmia neonatorum: prevalence and etiology. Med Sci Monit, 14 2 , CR Baynham, J. Antibacterial effect of human milk for common causes of paediatric conjunctivitis. Br J Ophthalmol, 97 3 , Bramantyo, T. Asia Pac J Ophthalmol Phila , 4 3 , Bremond-Gignac, D. Ophthalmology and Eye Diseases , 3 , 29— Bruschweiler-Stern N. The neonatal moment of meeting—building the dialogue, strengthening the bond.
Jul;18 3 Canadian Pediatric Society Preventing ophthalmia neonatorum. Paediatr Child Health;20 2 Antibiotic resistance threats in the United States, Accessed June 20, Sexually Transmitted Diseases Surveillance. Accessed November 12, Chen, J. Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis.
Pediatr Infect Dis J, 11 12 , Coutanceau, B. Case Rep Obstet Gynecol, , Darling, E. McDonald Diener, B. Cesarean section complicated by gonococcal ophthalmia neonatorum. J Fam Pract, 13 5 , , Dunn, P. Farroni, T. Eye contact detection in humans from birth. Ghaemi, S. The blindness in question results from infection with 1 of 2 sexually transmitted infections , chlamydia and gonorrhea often people get both at the same time.
Men and women can harbor chlamydia and gonorrhea infections without any symptoms. Obstetricians test most women for these infections during their pregnancies and treat them if their tests come back positive, but mothers can still pick up those diseases after their tests come back, so to be safe we treat everyone.
When this happens, only oral antibiotics provide effective treatment. There are several other reasons a baby might develop eye discharge in the first few weeks of life, including a rare allergic reaction to erythromycin. If your newborn develops thick, yellow discharge from one or both eyes, make sure a doctor sees him quickly. You may be trying to access this site from a secured browser on the server.
Please enable scripts and reload this page. Turn on more accessible mode. This is short-term. The medicine shouldn't be washed or cleaned out of the eyes. Vitamin K is important to blood clotting. Newborn babies normally have low levels of this vitamin until a few days after birth. The injection prevents vitamin K deficiency bleeding hemorrhagic disease of the newborn. Erythromycin belongs to the family of medicines called antibiotics.
Erythromycin ophthalmic preparations are used to treat infections of the eye. They also may be used to prevent certain eye infections of newborn babies, such as neonatal conjunctivitis and ophthalmia neonatorum. They may be used with other medicines for some eye infections.
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