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.

 

Kathleen Berchelmann, M.D. About Kathleen Berchelmann, M.D.

Kathleen M. Berchelmann, M.D., is a pediatrician at St. Louis Children's Hospital and Washington University School of Medicine, director of the St. Louis Children's Hospital Social Media Team, and co-founder of the ChildrensMD hospital physician blog. Her work has been featured in print and online publications including the St. Louis Post-Dispatch, the Chicago Tribune, and TIME magazine. She is a frequent contributor to Fox2 News STL Moms. Kathleen and her husband are raising five children.

Follow Dr. Kathleen Berchelmann on Facebook: ChildrensMomDocs Twitter: @MomDocKathleen and connect with her on .

Comments

  1. Dr R Allen Coffman says:

    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.

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

  3. 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.

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

    Thank you for sharing!

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