Eye Ointment For Newborns: Is It Necessary?

Erythromycin eye ointment is a standard procedure for newborns to protect their eyesight. This antibiotic ointment is applied to newborns' eyes within 24 hours of birth to prevent serious eye infections such as ophthalmia neonatorum (ON), which can be caused by gonorrhea, chlamydia, and other common bacteria. While some parents may question the necessity of this procedure, especially if they have tested negative for STIs, it is safer to prevent an eye infection than to treat one. ON can cause permanent damage to the cornea and even lead to blindness if left untreated. The use of eye ointment for newborns has been recommended by various medical organizations, and it is important to weigh the potential risks and benefits before making an informed decision.

Erythromycin eye ointment: what is it?

Erythromycin is a medication that belongs to the macrolide antibiotics family of drugs. It is used to treat certain eye infections, such as bacterial conjunctivitis, and to prevent bacterial eye infections in newborns.

Erythromycin eye ointment is routinely put into the eyes of all newborns to prevent neonatal conjunctivitis (also known as ophthalmia neonatorum), an infection that causes inflammation of the conjunctiva during the first four weeks of life. The conjunctiva is a thin layer of tissue that covers the inner part of the eyelid and the white part of the eye.

The use of erythromycin eye ointment in newborns dates back to the late 1800s when about 10% of newborns born in hospitals across Europe developed ophthalmia neonatorum, with 3% of those affected becoming blind. Today, erythromycin eye ointment is used to prevent bacterial infections in newborns, particularly those caused by chlamydia and gonorrhea, which are sexually transmitted infections. Chlamydia is the most common cause of ophthalmia neonatorum, while gonorrhea results in the most serious type.

Erythromycin eye ointment is applied by first washing your hands and tilting the head back. Gently pull down the lower eyelid to create a pouch and place a thin strip of ointment (about half an inch or one centimeter) into the pouch. Close the eye gently and roll the eyeball in all directions to spread the medication.

The use of erythromycin eye ointment in newborns is recommended by the U.S. Preventive Services Task Force and promoted by the American Association of Family Physicians. However, the American Academy of Pediatrics has called for a reevaluation of state mandates for its use, proposing a strategy that includes prenatal screening, testing at birth, counselling parents, and mandatory reporting of gonorrheal ophthalmia neonatorum cases.

Why do newborns get eye ointment?

Newborn eye ointment is a thin strip of antibiotic ointment applied under a newborn's lower eyelids within 24 hours of birth, usually in the first two to three hours of their life. Erythromycin ointment is the most commonly used antibiotic eye ointment for newborns in the U.S.

Newborns get eye ointment to protect them from serious eye infections caused by gonorrhoea, chlamydia, and other common bacteria. Mothers with sexually transmitted infections (STIs) can pass the infection to their newborns during childbirth, putting them at risk of ophthalmia neonatorum (ON), an eye infection that can cause blindness.

It is important that newborns receive eye ointment to prevent ON, which can cause permanent damage to the cornea and lead to blindness if left untreated. Antibiotic eye ointment can easily prevent ON shortly after birth.

Delaying the application of newborn eye ointment

While erythromycin ointment can blur a newborn's vision, this is only temporary. Parents can ask doctors or nurses to delay putting the ointment on their newborn's eyes for an hour or two to allow for skin-to-skin bonding and the first breastfeeding session.

Refusing eye ointment for newborns

While some parents may refuse eye ointment for their newborns, it is generally safer to prevent an eye infection than to treat one. Treatment for ON usually involves IV antibiotics and hospitalisation.

Is eye ointment necessary for newborns?

Within 24 hours of birth, a doctor or nurse will apply a thin strip of erythromycin ointment under a newborn's lower eyelids. This is known as "eye prophylaxis", a procedure that has been standard since the 1880s to prevent eye infections in newborns.

Newborns get eye ointment to protect them from serious eye infections caused by gonorrhoea, chlamydia, and other common bacteria. Mothers with sexually transmitted infections (STIs) can pass them to their newborns during childbirth, putting them at risk of ophthalmia neonatorum (ON), an eye infection that can cause blindness if left untreated.

It is important for newborns to receive eye ointment. If they do not, and the mother has gonorrhoea or chlamydia, there is a 30 to 50% chance that the bacteria will be passed on to the newborn. This can lead to ON, which can cause permanent damage to the cornea and blindness if left untreated.

In 2019, the U.S. Preventive Services Task Force reaffirmed its recommendation that all babies receive antibiotic ointment at birth. This recommendation is also supported by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, and the World Health Organization.

Delaying the application of newborn eye ointment

While erythromycin can blur a newborn's vision, their eyesight is not 20/20 to begin with. However, if parents want to make eye contact with their newborn, they can ask the doctor or nurse to delay putting on the ointment for an hour or two.

Refusing eye ointment for newborns

Some parents may want to refuse eye ointment for their newborns because they feel there is no chance they have an STI, or because they have heard that their baby's eyes can get irritated from the ointment. However, it is safer to prevent an eye infection than to treat one, and treatment for ON usually involves an IV antibiotic and hospitalisation.

Can you delay the application of eye ointment?

Erythromycin eye ointment is routinely applied to newborns to prevent ophthalmia neonatorum (ON), also known as neonatal conjunctivitis. ON is an eye infection that causes inflammation of the conjunctiva during the first four weeks of life. While ON is most commonly caused by chlamydia, a sexually transmitted disease, it can also be caused by gonorrhea, another sexually transmitted disease, as well as other bacteria.

ON is a serious condition that can lead to blindness if left untreated. In the late 1800s, about 10% of newborns in hospitals across Europe developed ON, and 3% of those infants were blinded by the infection. Today, the risk of blindness from ON is very low in countries where mothers have access to screening and treatment for sexually transmitted infections during pregnancy.

However, ON still occurs and can have serious consequences. In the United States, the Centers for Disease Control and Prevention (CDC) reported over 1,000 cases of gonorrhea and over 6,000 cases of chlamydia per 100,000 females in 2015. While these infections are less common among pregnant women, they can still occur and be transmitted to newborns during childbirth.

To prevent ON, erythromycin ointment is typically applied to the eyes of newborns within 24 hours of birth, usually in the first two to three hours of life. This ointment helps to kill or weaken bacteria in the eye, especially gonorrhea, and protect the infant from developing ON.

While erythromycin ointment is highly recommended and mandated in many U.S. states, some parents may consider delaying its application. Here are some points to consider regarding delaying the application of erythromycin ointment:

• Bonding and Breastfeeding: Some parents may want to delay the application of erythromycin ointment to facilitate skin-to-skin bonding and breastfeeding immediately after birth. Erythromycin can cause temporary blurred vision in newborns, which may interfere with early eye contact and bonding. However, it is important to note that newborns' eyesight is not 20/20 to begin with, and most infants are nearsighted.
• Risk Assessment: If the mother has been screened for sexually transmitted infections during pregnancy and is in a monogamous relationship with an uninfected partner, the risk of transmitting ON to the newborn is very low. In such cases, delaying or declining erythromycin ointment may be considered. However, it is important to discuss this with a healthcare provider, as there is still a small risk of infection.
• Effectiveness: While erythromycin ointment is effective in preventing ON caused by gonorrhea, its effectiveness in preventing ON caused by chlamydia is less clear. Some studies suggest that it may offer some protection, while others indicate that it is not effective. Additionally, there is limited evidence that erythromycin prevents ON caused by other types of bacteria.
• Alternative Prevention Methods: There are alternative methods to prevent ON, such as screening and treating sexually transmitted infections during pregnancy, using povidone-iodine eye drops, or using drops of the mother's first breast milk (colostrum). These methods may be considered as part of a comprehensive strategy to prevent ON, especially in regions with high rates of gonorrhea and limited access to prenatal care.
• Resistance: There is a growing problem of antibiotic resistance, and some strains of bacteria that cause ON, such as Streptococcus and Staphylococcus aureus, have developed resistance to erythromycin. This may reduce the effectiveness of erythromycin ointment over time.

In conclusion, while delaying the application of erythromycin ointment may be considered in certain low-risk situations, it is important to carefully weigh the risks and benefits. ON is a serious condition that can have long-lasting consequences, and prevention is always better than treatment. It is essential to discuss any concerns or questions about erythromycin ointment with a trusted healthcare provider, as they can provide personalized advice and guidance based on individual circumstances.

What are the risks of refusing eye ointment?

Ophthalmia neonatorum (ON), also known as neonatal conjunctivitis, is an infection that causes inflammation of the conjunctiva during the first four weeks of life. It is highly unlikely that a baby born by C-section could develop ON, as long as the mother's membranes were intact at the time of surgery.

The risks of refusing eye ointment for newborns include:

• ON can cause blindness in newborns.
• ON can cause permanent damage to the cornea.
• Treatment for ON is complicated and usually involves IV antibiotics and hospitalization.
• Erythromycin eye ointment is inexpensive and effective in preventing ON.
• Refusing eye ointment can increase the risk of ON, which can lead to serious eye damage and blindness.
• ON can progress rapidly and cause permanent vision loss within 24 hours if left untreated.
• Erythromycin eye ointment can help prevent gonorrheal ON, which is a serious form of ON.
• Erythromycin eye ointment may offer some protection against chlamydial ON, which is the most common cause of ON.
• Erythromycin eye ointment can reduce the overall bacteria in the newborn's eyes, which may lower the risk of ON.
• Erythromycin eye ointment is recommended by the U.S. Preventive Services Task Force and the American Association of Family Physicians.
• Refusing eye ointment can put the newborn at risk of infection with bacteria such as staph and strep, which are commonly found in the hospital and home environment.
• Erythromycin eye ointment can help prevent pseudomonal ON, which is at least as common as gonorrheal ON and can be severe.
• Erythromycin eye ointment is mandatory in many U.S. states to prevent ON and its serious complications.

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