Antibiotic Eye Ointment in Babies

In the hospital, one of the first things the delivery nurse is likely to do to your baby is spread a greasy concoction of antibiotic ointment into your baby’s eyes.  This ointment will certainly make it hazy during those early hours of trying to gaze at mom and learn to nurse.  A small price to pay if it is helpful in some way – but is it?

Understanding the Rationale

In the not too distant past both gonorrhea and chlamydia (sexually-transmitted diseases) were serious problems for babies.  Mothers who were infected with one or both of the bacteria generally passed it on to their new babies during delivery.  Many of these babies went on to get eye infections.  These eye infections have been given the fancy name – ophthalmia neonatorum.  The infection, if untreated, can be very serious and lead to blindness.

To combat this problem, some physicians started putting antibiotic ointment in the eyes of babies.  This seemed to make a big difference.  So the old mantra, “What is good for a few, is good for many” took over and now we have every baby in America getting the ointment in their eyes immediately after birth.

Fast-Forward to 2008

Today virtually every woman who is going to deliver a baby in America gets some sort of prenatal care.  As part of this prenatal care, women are screened for both gonorrhea and chlamydia.  If the screen is positive they are treated and retested until the test is negative.  Thus most women in America who receive prenatal care either do not have gonorrhea or chlamydia, or they are treated for it before they give birth.

So Why Do We Need to Treat the Babies Too?

This is a great question.  If you had prenatal care and your test was negative, the only way your baby can get ophthalmia neonatorum is through infidelity.  This means that you would have to contract the gonorrhea or chlamydia after your prenatal screen.  If you are in a monogamous relationship (and your partner is too), it is impossible to get either of these STDs.  However, if you cannot be certain of your partner’s commitment to fidelity, then I suppose you cannot be absolutely sure.

Does the Ointment Work?

Not really!  Most of the ointments used in hospitals DO NOT effectively treat chlamydia.  They only treat gonorrhea.  Worse, both of these infections also tend to get in baby’s lungs where they can cause pneumonia  The ointments are completely useless against pneumonia.

Is the Ointment Harmful?

It may causes a chemical conjunctivitis is 9-14% of babies.  A chemical conjunctivitis is irritation of the whites of the eyes.  It is generally not serious in that it will not cause blindness.  However, why subject your baby to it unless there is a good reason?

My Advice:

Get prenatal testing.  Be faithful to your spouse.  Decline the eye ointment.

My Experience… As a Parent

I now have two children.  My first son was born in Iowa.  When we were admitted to the hospital for the delivery, we gave the nurse a copy of our birth plan which explained we would like to decline the use of antibiotic eye ointment.  They gave us a piece of paper to sign and that was the end of it.

We have since moved to Texas and recently had our second son.  When we asked about declining the antibiotic eye ointment this time, we were told that we could decline it but that we would get a visit from Child Protective Service (CPS).  We were told that the State of Texas has legislated that the eye ointment must be given to all babies.  Just the kind of dysfunction and waste you would expect when politicians start trying to play doctor.

Of course, I declined it anyway feeling that I was ready to do battle with CPS should they actually show up at my door.  Seems to me that there are enough children being abused, neglected, and otherwise harmed, that CPS probably has better things to do that fight with me over this unnecessary ointment.

Not surprisingly, the threats were little more than intimidation.  No one came knocking on my door and I still have custody of both my children.  I did hear during one conversation though that CPS will show up if your child develops ophthalmia neonatorum in the setting of parental refusal of the eye ointment.  Of course this makes sense.  If you cannot be faithful to your spouse and put your child at risk on account of this unfaithfulness … you probably deserve a visit from CPS.

References:

Pediatric Infectious Disease Journal (1992)

This article compared 4 different antibiotic eye treatments to no treatment.  There was no difference in the rate of chlamydia conjunctivitis.  Interpretation: The eye ointment was completely useless in the prevention of chlamydia eye infections in babies.

New England Journal of Medicine (1989)

This article points out that in a study of 12,431 pregnant women and their newborns, 8 babies developed gonorrhea eye infections (0.06%).  Of these mothers 7 did not get prenatal care.  Interpretation: If you get tested for gonorrhea, which all women do as part of their prenatal care, there is little reason to think your baby will get an eye infection from gonorrhea.

New England Journal of Medicine (1995)

This article summarizes three different treatments for newborn eye infections.  It also mentions the rate of chemical conjunctivitis, which is caused by the treatment itself.  Up to 13.9% of babies will get eye irritation from the treatment itself.  Impression: If you can be certain your baby is at zero risk for contracting gonorrhea or chlamydia, the ointment will do little for your baby other than give them about a 1 in 6 chance of getting eye irritation.