Routine use of eye antibiotics in newborns

I am expecting a baby in five weeks and would like your opinion on the routine use of silver nitrate (and/or other antibiotic solutions) on a newborn's eyes. My understanding is that this procedure was intended to prevent the spread of gonorrhea from infected mothers to their infants, yet I have never had this disease nor do I suffer from it now. Should I decline this routine treatment? What are the benefits and what are the risks?

Thank you so much for any information you can give me!

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

The practice of placing antibiotic solution and ointment in the eyes of newborns shortly after birth is common throughout the world. This strategy revolutionized preventative care for newborn babies because it dramatically decreased the number of infections of neonatal conjunctivitis or eye infections of the newborn. Here in the United States, it is mandated by law in certain states. The purpose of this is to prevent infection of tissues surrounding the eyes caused by certain bacteria which may be present in the birth canal as the baby is being born.

The most significant of these bacteria are the ones that cause the sexually transmitted diseases gonorrhea and chlamydia. However, the use of these antibiotic drops or ointment also help prevent infection with more "run-of-mill' bacteria which may also be acquired shortly after birth. Left unchecked, the gonorrhea and chlamydia bacteria can cause permanent visual impairment and also spread to other parts of the body such as the lungs causing pneumonia. And with 4 million people in the United States that are currently estimated to have chlamydia infections, there are thousands of babies that are potentially benefiting from the use of these topical antibiotics.

But of course there are many women who find this strategy of treating all infants somewhat personally offensive. Why treat the babies of women who clearly have no history or symptoms of these sexually transmitted diseases? Unfortunately, it comes down to numbers. Clearly, there are millions of women who have these infections. And although gonorrhea usually creates symptoms in women that cause them to seek medical attention, that is not the case for chlamydia. In fact, between 50-70% of women with chlamydia have no symptoms whatsoever. They therefore do not receive treatment and put their babies at risk for getting the infection. Most women have a culture done early in their pregnancy to detect these infections as part of their usual prenatal care. However, false negatives are unfortunately common with these screenings. In other words, accurately predicting which babies are at risk for these eye infections is virtually impossible, so treating all of them is the only way effectively limit the infection.

While it is certainly within your right to decline this treatment for your baby, I would advise that he or she receive the antibiotic. I realize you feel the risk of him getting a gonorrhea or chlamydia infection is zero. However, the advantage is that you significantly lower the risk of him (her?) getting an eye infection whether that be from a common bacteria or sexually transmitted one. The disadvantage is that with silver nitrate, there is a higher incidence of the tissue around the eye becoming mildly inflamed for a couple of days due to irritation. My personal preference is erythromycin ointment because few if any babies get significant irritation from the ointment. You may want to discuss the antibiotic options with the nursery who will help take care of your baby shortly after birth.

Congratulations on your new addition to the family!

I hope this helps.

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