Ophthalmia neonatorum prevention

Treatment of gonorrhea during pregnancy is essential to prevent ophthalmia neonatorum. The CDC recommends that either tetracycline (1%) ophthalmic ointment or erythromycin (0.5%) ophthalmic ointment be instilled in each conjunctival sac immediately postpartum to prevent ophthalmia neonatorum. 

Biological and medicinal aspects of silver chemistry are covered in Chapter 62 but a number of features will be outlined here. Silver salts are powerful bacteriocides and it has been known for many years that storing water in silver vessels prevents spoilage. Silver nitrate is highly corrosive and can be applied locally to remove warts or cauterize wounds. In many states in the USA, a 1% AgN03 solution is dropped into the eyes of newborn infants to prevent ophthalmia neonatorum. Silver sulfadiazine has been found effective as a topical application to prevent infections in serious bums victims. 

A fixed-combination ointment containing oxytetracy-cline and polymyxin B is available for topical ocular use (see Table 11-6). The Centers for Disease Control and Prevention recommends ophthalmic ointments containing a tetracycline or erythromycin as an effective alternative to silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum. A major advantage of using an antibiotic ointment such as oxytetracycline-polymyxin B is that it does not canse the chemical conjunctivitis typically produced by silver nitrate. 

Silver nitrate 1% (used in neonates to prevent ophthalmia neonatorum) Tetracycline HCL (Achromycin Ophthalmic) (tobramycin 0.3% and dexamethasone 0.1%)... 

Dunn, Peter M. Dr Carl Crede (1819 1892) and the Prevention of Ophthalmia Neonatorum. Archives of DiAeaAeA in Childhood (September 2000) F158F159. Also available online at http //fn.bmjjournals.eom/cgi/content/full/83/2/F158 (accessed on November 5, 2005). 

Erythromycin ophthalmic ointment is the medication of choice to prevent ophthalmia neonatorum (blindness caused by a gonorrhea infeetion acquired when passing through the birth canal or coming into contact with the mother s tissues). Because the client has had no prenatal care, this would be recommended procedure in case the infant has been exposed to gonorrhea. 

Though silver nitrate causes chemical conjunctivitis in about 90% of the infants in the first 24 hours of life, obvious conjunctivitis is rare after this period. The chemical conjunctivitis does not increase the risk of secondary infection, nor does it mask bacterial infection. Rinsing will not prevent the development of conjunctivitis. Discontinuation of the prophylactic use of silver nitrate appears to result in a significant rise of gonococcal ophthalmia neonatorum in high-risk populations. 

Argyrosis has occurred in many patients treated with silver nitrate. Several cases of chemical burns of the eyes in newborn babies have been reported, but most of these cases arose following incorrect administration of the preparation (SED VIII, pp. 521 and 545). The specific use of the product in the prevention of ophthalmia neonatorum is further discussed in Chapter 20. 

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