Many
of my patients refuse neonatal eye care.
They do this after having read information on their own and discussing
the issue at length with me during a prenatal visit in my office.
This is a controversial issue and the vast majority of doctors
and experts recommend giving the treatment shortly after birth.
Nonetheless, there is research to suggest that this routine may
not be necessary.
Obviously, this represents a minority point of view both in the
hospital and in the pediatric community in general.
I have added my own emphasis to these articles.
Pediatrics
1993 Dec;92(6):755-60
Randomized trial of silver
nitrate, erythromycin, and no eye prophylaxis for the prevention
of conjunctivitis among newborns not at risk for gonococcal ophthalmitis.
Eye Prophylaxis Study Group.
Bell TA, Grayston JT, Krohn MA, Kronmal RA
Department of Biostatistics, University of Washington, Seattle
98195.
OBJECTIVE. To compare the efficacy of commonly used forms of eye
prophylaxis for newborns with no prophylaxis in the prevention
of nongonococcal conjunctivitis. DESIGN. Randomized doubly masked
clinical trial. SETTING. University of Washington Hospital and
affiliated clinics, Seattle, between 1985 and 1990. SUBJECTS.
The medical records of 8499 women were evaluated for possible
participation; 2577 were eligible. Of the 758 enrolled, the infants
of 630 were evaluable. INTERVENTION. Comparison of silver nitrate,
erythromycin, and no eye prophylaxis given at birth for the prevention
of conjunctivitis. MAIN OUTCOME MEASURES. Conjunctivitis during
the first 60 days of life and nasolacrimal duct patency in the
first 2 days of life. RESULTS. The frequency of impatent tear
ducts at the 30- to 48-hour examination did not differ significantly
by prophylaxis group. Among the 630 infants randomized and
observed, 109 (17%) developed mild conjunctivitis. Sixty-nine
(63%) of the cases appeared during the first 2 weeks of life.
After 2 months of observation, infants allocated to silver nitrate
eye prophylaxis at birth had a 39% lower rate of conjunctivitis
(hazard ratio = 0.61, 95% confidence interval = 0.39 to 0.97),
and those allocated to erythromycin had a 31% lower rate of conjunctivitis
(hazard ratio = 0.69, 95% confidence interval = 0.44 to 1.07),
than did those allocated to no prophylaxis. CONCLUSION. Silver
nitrate eye prophylaxis caused no sustained deleterious effects
and even provided some benefit to infants born to women without
Neisseria gonorrhoeae. However, the effect was modest and against
microorganisms of low virulence. The results suggest 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.
Pediatr
Infect Dis J 1992 Dec;11(12):1026-30
Prophylaxis
of ophthalmia neonatorum: comparison of silver nitrate, tetracycline,
erythromycin and no prophylaxis.
Chen JY
Department of Pediatrics, Chung Shan Medical and Dental College
Hospital, Taichung, Taiwan, Republic of China.
From November, 1989, to October, 1991, 4544 neonates were born
at our hospital. Neonatal ocular prophylaxis immediately after
birth was used with 1% tetracycline ophthalmic ointment in 1156
neonates, 0.5% erythromycin ophthalmic ointment in 1163 neonates
and 1% silver nitrate drops in 1082 neonates. No prophylaxis for
neonatal conjunctivitis was given to 1143 neonates. A total of
302 infants (6.7%) developed conjunctivitis during the first 4
weeks of life. Between December, 1991, and January, 1992, 425
neonates were born at our hospital and all were given 0.5% erythromycin
ophthalmic ointment twice in the first 24 hours after birth for
ocular prophylaxis. Thirty-one (7.3%) infants developed conjunctivitis
during the neonatal period. 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. We conclude 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.
5:
Am J Epidemiol 1993 Sep 1;138(5):326-32
The bacterial etiology of conjunctivitis in early infancy. Eye
Prophylaxis Study Group.
Krohn MA, Hillier SL, Bell TA, Kronmal RA, Grayston JT
Department of Epidemiology, School of Public Health and Community
Medicine, University of Washington, Seattle.
The authors conducted this study to determine the etiologic agents
of conjunctivitis in early infancy. From 1985 to 1990, 630 infants
enrolled in a randomized, controlled, double-masked study of eye
prophylaxis were observed for 60 days after delivery for signs
of conjunctivitis. The following isolates were categorized as
pathogens: Haemophilus influenzae, Streptococcus pneumoniae, Neisseria
cinerea, Klebsiella pneumoniae, and Chlamydia trachomatis. Using
conditional logistic regression for analysis of 97 infant pairs,
the authors identified isolates categorized as pathogens almost
exclusively among cases (odds ratio (OR) = 18.0, 95% confidence
interval (CI) 2.3-128). Among the microorganisms which have not
usually been regarded as pathogens in the etiology of infant conjunctivitis,
Streptococcus mitis was the only microorganism associated with
an increased risk of conjunctivitis (OR = 5.3, 95% CI 1.8-15.0).
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.
14:
Pediatr Infect Dis J 1989 Aug;8(8):491-5
Failure of erythromycin ointment
for postnatal ocular prophylaxis of chlamydial conjunctivitis.
Black-Payne C, Bocchini JA Jr, Cedotal C
Department of Pediatrics, Louisiana State University School of
Medicine, Shreveport 71130.
Chlamydia trachomatis is the most common pathogen associated with
conjunctivitis during early infancy in the United States. During
a 13-month interval at our medical center 4834 infants were born,
311 of whom (6.4%) had conjunctival specimens tested for chlamydial
antigen before the age of 12 weeks. In 44 (14% of all tested infants,
0.9% of live births) chlamydial antigen was present. Because the
rate of asymptomatic maternal chlamydial endocervical colonization
is estimated to be 26% at our institution (previous prospective
study), we calculated a minimal failure rate for erythromycin
ocular prophylaxis of from 7 to 19.5%. A subsequent case-control
study revealed that mothers of infants with chlamydial conjunctivitis
were more likely to be primiparous (P = 0.03) and experience longer
duration of rupture of membranes before delivery (P = 0.046).
We conclude that a substantial percentage of infants exposed
to Chlamydia develop chlamydial
conjunctivitis despite receiving erythromycin ocular prophylaxis.
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