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.


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.

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9 Responses to Antibiotic Eye Ointment in Babies

  1. Melinda says:

    How do you decline? I did this with my first but have since tried to learn exactly what is going on. We are due in March, do I just need for my husband to make sure he declines when they go off to the nursery, or do I need to have something wrote up and possibly notarized?

  2. janett says:

    You decline, by letting your OB/GYN know well in advance. Also make sure the maternity ward staff knows what you do, do not want for your baby. The other way is to let your partner or whomever is going to be with you know what you want. I have created a birth plan that I will give to my dr. and the hospital. Also do not let the baby out of our sight, if possible. If they get ready to do something you do not want or know about, tell them to stop. Do not let anyone change your mind to what you feel is best.

  3. maria says:

    I live in england and our healthe service do not screen us for chlamydia as a result my grandaughetr who is 3 weeks old has got an eye infection caused by chlamydia. it is very distressing to see blood and puss weeping out of her eye. why cant our health service have the test put in place for all new mothers to be.

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  5. b says:

    What an idiot you are. A simple tube of eye ointment that can prevent blindness, who would not allow this to be done. I am and L & D nurse in Iowa and it is mandatory. So I don’t know where you delivered but it has to be done. Prevent blindness or not. WOW as a parent that is a no brainer!

  6. DrReynolds says:

    L&D Nurse –

    I normally do not post inflammatory comments such as this one. However, in this case I want to make an exception because this comment unfortunately demonstrates the uninformed, arrogant, elitism that many parents must deal with when trying to deliver their children. Facts not job title (L&D nurse, pediatrician, or otherwise) should guide the decisions we make and the medical management that we (the parents) choose.

    Issue #1: It is in fact NOT mandatory in Iowa. Of course the arrogant elite would like to mandate all kinds of things for those lesser peasants out there in the community that just don’t know how to run up an unnecessary medical bill. It turns out in Iowa, at least when I was there, you still had control over most of the medical care of your children. If you did not want something, then you did not have to get it. There are a few exceptions (like newborn testing). Eye ointment is NOT one of those exceptions. If you do not want this, simply sign a waiver that you don’t want it and that is it.

    Issue #2: The ointment only prevents blindness in babies born to mother who have gonorrhea or chlamydia. If you do not have gonorrhea or chlamydia then this ointment does absolutely nothing for your children (other than irritate their eyes, blur their vision during those first precious moments on mom’s chest, and run up your medical bill). If you have previously tested negative and you are certain that you are in a monogamous relationship, then it is IMPOSSIBLE for your baby to get gonorrhea or chlamydia of the eyes. If you cannot be 100% certain you are in a monogamous relationship – better get the ointment.

    Issue #3: An irresponsible parent is one who declines the eye ointment without understanding the things I have mentioned above. A SmartParent knows when it is safe to decline unnecessary medical treatments. An idiot is one who does not know the difference.

  7. K says:

    Thanks for a well written, and informative piece! It’s difficult to get a straight answer on this issue, particularly one that is not permeated by judgment instead of evidence. It seems clear from your article, but just to be sure: the ointment does nothing in regards to infection risk from GBS positive moms? Thanks in advance!

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  9. DrReynolds says:

    True. It provides no protection against GBS.

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