General Health & Wellness • Aug 15, 2013

Do newborns really need that eye ointment?

Usually yes, sometimes no.

Just minutes after I delivered my first child a nurse squirted antibiotic ointment into his eyes.  My husband asked what it was for, and I called from bed, “It’s in case I have an STD.”  The nurse laughed at my frank answer, but my husband was quite horrified.  So what is that antibiotic eye ointment newborns get and what is it for?  Do all new babies really need it?  Is it safe to decline this medicine for my newborn?

NewbornEyeScreenIlotycin is an antibiotic ointment is routinely put in the eyes of all newborns to prevent neonatal conjunctivitis (pink eye).  While Chlamydia and Gonorrhea are the most serious pathogens that are treated with ilotycin, this treatment also prevents less severe infection with other common bacteria such as e. coli.  These common bacteria are found in everyone’s genital/rectal area.  The medical term for newborn eye infections is “ophthalmia neonatorum.”  These infections are obtained during passage through the vagina.  Neonatal conjunctivitis can cause blindness, yet is easily prevented by antibiotic eye medications shortly after birth.  Babies born by c-section are still at risk for neonatal conjunctivitis if there was any vaginal rupture of membranes prior to delivery.

The state of Missouri, like many states, actually mandates prophylactic treatment for newborn eye infections, although parents do have the right to decline treatment.

I get a lot of questions about antibiotic eye ointment for newborns.  Here are the most common:

“I have zero risk of having an STD.  My baby doesn’t need eye antibiotics.”

Answer: The antibiotic ointment also protects against other common bacteria that can be found the vagina and rectal area.

“My baby is being born by c-section, so she doesn’t need eye antibitoics.” 

Answer: As long as there was no vaginal rupture prior to c-section, risk of ophthalmia neonatorum is essentially zero.  You are fine to decline eye antibiotics.

“If my baby gets an eye infection, we can treat it then.” 

Answer: Ophthalmia neonaturm can be rapidly progressive and cause permanent damage to the cornea.  Treatment is complicated and usually involves IV antibiotics and hospitalization.  Preventative medicine is best.  Risks of eye antibiotic are limited to rare eye irritation, which is much less since switching from the older treatment of silver nitrate to the ilotycin antibiotic ointment that we now use.  The benefits of preventative treatment outweigh the risks.

“I want to delay eye antiobitics so that my baby can see me.”

It is absolutely fine to delay for a few hours or until mom and baby have bonded and/or breastfed for the first time.  In fact, there is some evidence that giving eye antibiotics before a baby has nursed for the first time impedes the baby’s ability to see and latch onto mom’s breast.  We’ve changed our procedures at Barnes Jewish Hospital so that baby and mom spend their first few minutes together and eye ointment and other newborn care comes later (as long as baby is healthy).

A growing number of parents decline antibiotic eye ointment for their newborns.  You are welcome too, also.  Just discuss it with your pediatrician before delivery.  Babies used to go blind from eye infections.  Now we almost never see it— I’ve seen one case in my career.  I’ve never seen any side effect from the antibiotic eye ointment, either.

As for me, I do let all my own babies get antibiotic eye ointment shortly after birth, even though I have no personal concerns for STDs.  I do wait until after they have breastfed for the first time.  As for my husband, he recovered from his initial shock, and he’s fine with the antibiotic eye ointment, too.

 

Comments

  • Dr R Allen Coffman

    Excellent post. I would add that most experts believe that babies bond by skin contact and smell not from vision at birth. Visual acuity is poorly developed and the visual cortex is not developed. So, some ointment will have little impact on any visual component of bonding.

  • Juliet

    Can you reference any studies where other bacteria (non-STD) have caused blindness in newborns who did not receive the eye ointment?

  • Could you please provide references for your statement that erythromycin prevents non-chlamydial and gonorrheal eye infections? I did an extensive search on pubmed and as far as I can tell, it has never been studied for that purpose.

  • Everything is very open with a precise description of the
    issues. It was definitely informative. Your website is useful.

    Thank you for sharing!

  • Tammie

    Don’t put your baby through this. Common sense tells us it’s not necessary and it is NOT good for your baby. It’s also just one more way of telling women that their bodies “aren’t good enough” as is and are “dirty” (oh so full of damaging “bacteria” and who knows what else!) Funny that societies before this crap was forced on us weren’t full of blind people…where are the multitudes of blind people in those history books??

    Bond with your baby right away. Look into your babies eyes. Skip the pharmaceuticals that are making someone wealthy who does not give one iota about your baby.

  • Amy

    I’m another person asking for your medical references that state ON can be contracted by another bacteria other than Chlamydia or Gonorrhea.

  • zed

    I assuming you are referring to erythromycin eye ointments, but you never actually make this clear.

    1. You state that eye ointment prevents other eye infections (e.g. from e. coli), not just those caused by chlamydia or gonorrhea — but another source I’ve read, which *does* generally cite sources, claims that NO study has been conducted to test this — claiming that is can treat anything else is pure speculation. Would you please provide a reference?

    2. Q: “If my baby gets an eye infection, we can treat it then.” You answer is that “the benefits of preventative treatment outweigh the risks [of treatment after symptoms appear].” — then why does the United Kingdom only treat ON after symptoms? Is there any evidence that the UK is practicing the wrong policy?

    My questions come from reading http://evidencebasedbirth.com/is-erythromycin-eye-ointment-always-necessary-for-newborns/ … I’m totally inexperienced, but I’m inclined to trust articles that attempt to cite sources.

  • sam

    http://www-ncbi-nlm-nih-gov.ezproxy.lib.utah.edu/pmc/articles/PMC4114003/
    this one is a short study on he effectiveness of two prophylactic eye treatments and found all conjunctivitis infections were from Staphylococcus aureus

    http://jama.jamanetwork.com.ezproxy.lib.utah.edu/article.aspx?articleid=372547
    Erythromycin Ointment for Ocular Prophylaxis of Neonatal Chlamydial Infection. found erythro to be effective in prophylaxis

    https://redbook.solutions.aap.org/DocumentLibrary/RB2009.pdf pg 827 talks about other types of infections,

    http://www.sciencedirect.com.ezproxy.lib.utah.edu/science/article/pii/S0140673686905441 this reference also talks about the various organisms causing ON

  • Chi

    My wife has given birth to both our children at home. Needless to say, we did not inject them with toxic “immunization’ (real “immunization” comes from the milk folks, and even though the baby may not be “immune” to whooping cough and all the other bs dis eases that 99 percent of people are afraid of.)
    nor did i abuse my son when he was born and have his penis sliced and diced. and of course, no anitbiotics in the eyes…lol. seems so insane that this is just the status quo. people are so filled with fear these days, that even if its only a .001 percent chance anything will happen, they like to HURT their babies to “protect” them from such things. a hospital is the very last place one should birth a being into this world. its a place filled with sick people. a pregnant women is not sick. its a natural process. anyone who thinks its a good idea to do these things, is IMO, crazy. abuse is abuse.

  • Selena

    Wow these comments are moronic. Yes, believe it or not, your body does have ‘oh so damaging bacteria’. I’m 100% against the patriarch and men telling us our bodies are dirty, but this is not that. Have you ever had a yeast infection? Or how about a UTI? E. coli along with tons of other bacteria are found in your GI tract and in turn, perineal area(that’s your gnitals, guys). Do you know where babies come from? Your gnitals. No vginas aren’t ‘dirty’, but the human body is filled with bacteria and can cause things to go wrong with your infant. And for the high and mighty guy with the whole “immunization is the milk”, there’s this thing called temporary immunization, where your kid gets moms antibodies for a little bit, BUT THAT DOESNT LAST. Immunize your kids people and for the love of God read an article before you go spewing this bs. I hope your kid gets the plague

  • Erin Mooney

    Hoping someone’s child gets the plague is the most moronic & asinine comment I have ever read. Any points you made in your comment were negated by the last sentence you wrote. You, my dear, are a complete asshole. Regardless if someone believes in immunization or not gives you no right to wish the plague upon their child. As a mother you should be building other mothers up, not tearing them down with insensitive & unnecessary comment. You are what is wrong with the world today.

  • Adel Torres

    I’m sorry, but three of these link to a site that requires a membership, and I don’t see any way to set one up. The third link to the 28th edition of the RedBook produced the following quote, which I would say supports the clear ambiguity of this argument: “Silver nitrate, povidone-iodine, and probably erythromycin are effective for preventing nongonococcal, nonchlamydial conjunctivitis during the first 2 weeks of life.” Can those other studies be found anywhere else?

  • Sadie Powell

    I had whooping cough as a baby. I got it just before I turned 2 months old. I was in the hospital for 2 months and I have permanent damage to my lungs from this and being born with underdeveloped lungs. I struggle with asthma everyday. I could have died from whooping cough because someone decided not vaccinate their child and that child gave me whooping cough. It offends me that you would call whooping cough a bs disease. I don’t get the flu shot or STD vaccines for my baby but the other vaccines are important and they were invented to keep people from getting diseases that ravaged so many families and cause many parents to bury their children or vice versa. To say these diseases are bs is to ignore history. It’s just irresponsible.

  • Susan Greer

    I’m not anti vax, but I must clarify a statement you made. You stated that the immunity from mother’s milk is temporary; I have to clarify that it is temporary until she stops nursing. During the entire nursing relationship the baby enjoys bioactive components to its mother’s milk, that helps in building its immune system; and if mother properly nourishes her child for the entire span that a child needs milk, the child enjoys the immunoglobulin. Also, if the baby contracts something mom is immune to while nursing, mom’s milk can help baby fight it, all the while building their own immunoglobulin profile.

    So yes, mother’s help is temporary, by in providing the appropriate milk source for four years, she will help set up her baby’s immune system for life. Oh, and no she doesn’t have to suckle her toddler or preschooler, she can express and give milk in a cup (typically at meal times).

  • RM25483

    “Where are the multitudes of blind people in those history books?”
    Did you try looking it up? Do a simple Google search for history Europe’s blindness due to infant ophthalmia neonatorum… the results may astound you.

  • RM25483

    Sorry for your situation; I deal with my own lifelong issues.

    How do you know that you contracted whooping cough from an un-vaccinated individual? The US CDC claims that the vaccine is only 80-90% effective for infants [https://www.cdc.gov/pertussis/pregnant/mom/vacc-effectiveness.html]. That 90% figure is only reached if the mother gets the shot _during_ pregnancy.