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Newborn eye prophylaxis refers to the practice of eye drops or ointment containing an antibiotic medication being placed in a newborn's eyes after birth. This is required by law to protect the baby from an unknown Gonorrhea or Chlamydia infection in the mother's body. The primary signs of an eye infection (conjuctivitis) in a newborn are redness and swelling of the lids and sclera of the eye.Erythromycin ointment, the antibiotic most commonly used, is a controlled substance in Virginia. Licensed midwives are not permitted to carry or administer it at this time. If you choose to have your baby receive this preventative treatment, you will need to obtain a prescription from your family or pediatric physician so that you can administer it to your baby immediately after the birth.ROUTINE TREATMENTThere are studies that show that routine administration of eye ointment does not confer significant reduction of eye infections as opposed to no treatment.

Bell TA, Grayston JT, Krohn MA, Kronmal RA. Randomized trial of silver nitrate, erythromycin, and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis. Pediatrics 1993 Dec;92(6):755-60.

Eye Prophylaxis Study Group. Department of Biostatistics, University of Washington, Seattle 98195. The results suggested that parental choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy.

Chen JY. Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis. Pediatr Infect Dis J 1992 Dec;11(12):1026-30.

The incidence rates of neonatal chlamydial conjunctivitis in the tetracycline, erythromycin, silver nitrate, no prophylaxis and erythromycin twice groups were 1.3, 1.5, 1.7, 1.6 and 1.4%, respectively. The authors concluded that neonatal ocular prophylaxis with erythromycin (one or two doses) or tetracycline or silver nitrate does not significantly reduce the incidence of neonatal chlamydial conjunctivitis compared with that in those given no prophylaxis.

Krohn MA, Hillier SL, Bell TA, Kronmal RA, Grayston JT. The bacterial etiology of conjunctivitis in early infancy. 5:Am J Epidemiol 1993 Sep 1;138(5):326-32.

The findings concerning the species of bacteria most often associated with conjunctivitis, as well as the finding that method of delivery is unimportant, suggest that bacteria were transmitted to the infants' eyes after birth and not from the birth canal.

Black-Payne C, Bocchini JA Jr, Cedotal C. Failure of erythromycin ointment for postnatal ocular prophylaxis of chlamydial conjunctivitis. 14: Pediatr Infect Dis J 1989 Aug;8(8):491-5.

The conclusion was that a substantial percentage of infants exposed to Chlamydia develop chlamydial conjunctivitis despite receiving erythromycin ocular prophylaxis.ALTERNATIVE TREATMENTS

Screening and treating for Gonorrhea or Chlamydia in pregnancy is a very good way to prevent spreading these infections to your baby. Most women will experience some kind of symptoms with both of these infections, but risk factors such as multiple sexual partners can increase the chance of undiagnosed vaginal infections.

Most babies are born with their tear ducts still closed. Without tears, they are unable to rinse their eyes of dust and other irritants. We usually recommend a few drops of your breast milk as a "rinse" of the crusty discharge that often develops in your baby's eyes during the first few weeks of life. This discharge can be clear or yellow and does not indicate an infection is present. Good handwashing (especially after diapering) is an important component of reducing exposure to unfriendly bacteria. If your baby does develop an eye infection, antibiotic treatment is still an option, as well as herbal rinses of chamomile, eye bright, echinacea, and goldenseal.

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