All About Erythromycin Eye Ointment Given to Babies at Birth

Usually referred to as the “golden hour,” the primary 60 minutes after delivery are an important bonding time for a mom and her child. Until there’s a medical emergency or the mom or child is unstable, medical suppliers ought to delay all procedures and interventions till after the new child’s first feeding or not less than one hour after supply.1

Nonetheless, there are some procedures and interventions really helpful very quickly after delivery. As a NICU nurse, one of many first interventions we carry out when new infants arrive on the unit is “eyes and thighs.” The “eyes” refers to erythromycin eye ointment, and “thighs” refers to a shot of vitamin Ok within the thigh. Erythromycin eye ointment is routinely given to newborns after delivery to stop and deal with bacterial infections.

What’s Erythromycin Eye Ointment?

Erythromycin is a macrolide antibiotic for treating sure bacterial infections comparable to strep, gonorrhea, chlamydia, and HiB. The sort of antibiotic works by stopping the expansion of micro organism.2,3

Erythromycin ointment is a topical formulation of this antibiotic, which means that as an alternative of being administered by the mouth, vein, or muscle, we apply it to the attention’s mucous membrane, and the physique absorbs it that approach. It supplies localized therapy to guard the eyes from bacterial hurt.4

Topical erythromycin eye ointment can stop a situation in new child infants referred to as ophthalmia neonatorum.

What’s Ophthalmia Neonatorum?

Ophthalmia neonatorum is when a child will get conjunctivitis or pink eye throughout the first month of life. Pink eye in newborns is often because of the Neisseria gonorrhoeae bacterium, which causes sexually transmitted gonorrhea an infection.5

Gonorrhea in girls sometimes doesn’t trigger any signs, so a pregnant mom might not even know she is contaminated and, due to this fact, wouldn’t know to hunt therapy. If a mom has untreated gonorrhea, her child has a 30-50% likelihood of catching it from her throughout delivery, referred to as vertical transmission. Infants who contract gonorrhea from their moms throughout supply will develop ophthalmia neonatorum.5,6

Ophthalmia neonatorum causes signs comparable to eye redness, profuse discharge, extreme swelling of the eyelids, corneal scarring, ocular perforation, and blindness. Signs can start as quickly as 24 hours after an infection and sometimes inside 2-5 days. One eye could also be worse than the opposite, however generally each eyes are affected. Neonatal pink eye progresses quickly and may trigger everlasting injury to the eyes.5,7,8,9

If left untreated, ophthalmia neonatorum can progress to systemic illness, inflicting signs comparable to sepsis and arthritis.10

Though gonorrhea is the commonest reason for ophthalmia neonatorum, different micro organism and pathogens may trigger this situation. As an example, chlamydia is turning into one other frequent reason for neonatal pink eye. Erythromycin doesn’t stop or deal with different causes of this situation as successfully because it treats the gonorrheal reason for pink eye.7,11

When Will the Ointment Be Utilized?

Since signs of neonatal pink eye can start as quickly as 24 hours after delivery, medical doctors or nurses ought to apply erythromycin ointment as quickly as potential after delivery. The CDC recommends administration throughout the first 2-3 hours of life, however many hospitals purpose for even sooner.9,10

The infant should not be moved from the mom’s chest to manage erythromycin. Ointment administration shouldn’t interrupt the golden hour.

Elements in Erythromycin Eye Ointment

The substances within the ointment embody:14

  • Erythromycin. 0.5%
  • Mineral oil. A liquid obtained from petroleum. The Environmental Working Group charges this product as having a low danger for most cancers and developmental and reproductive toxicity, and a average danger for allergy and immunotoxicity, particularly if inhaled. The mineral oil in erythromycin eye ointment is utilized topically with little likelihood of inhalation.12
  • White petrolatum. A semisolid combination obtained from petroleum. The Environmental Working Group charges this product as low danger for most cancers, allergy symptoms, immunotoxicity, and developmental and reproductive toxicity.13

Aspect Results and Dangers

Erythromycin eye ointment is mostly thought-about secure. Some consultants suspect that erythromycin ointment administration causes momentary blurry imaginative and prescient for the new child that will impair bonding by affecting eye contact between the toddler and oldsters. The ointment could cause the looks of cloudy eyes, and it could actually additionally trigger eye redness, swelling, and irritation.15

Not often can an allergic response to erythromycin eye ointment happen. If it does, an allergic response causes eye discharge within the first few weeks. Nonetheless, it’s rare for a child to have an allergic response to their first publicity to an antibiotic.16

One other potential aspect impact of the erythromycin eye ointment is antibiotic resistance. This happens when micro organism adapt to outlive therapy. This makes antibiotics much less efficient over time and explains why we shouldn’t use them when they’re pointless. It’s unknown whether or not gonorrhea has developed resistance to erythromycin, however the U.S. Preventative Companies Activity Drive has recognized this as an essential space for additional analysis.5

Who Ought to Get Erythromycin Eye Ointment?

The American Academy of Household Physicians recommends all newborns obtain erythromycin eye ointment to stop gonorrheal neonatal pink eye. As a result of many ladies with gonorrhea don’t have any signs and a few girls both don’t obtain prenatal care or have poor care, the AAFP believes erythromycin eye ointment is a secure and easy technique to stop the extreme penalties of ophthalmia neonatorum, together with blindness.17

Is the Ointment Obligatory?

Erythromycin eye ointment is the usual of care in the US. Most states mandate its use, and your supplier or pediatrician ought to know your state’s legal guidelines and the insurance policies on the hospital the place you propose to ship. If you wish to decline therapy with erythromycin eye ointment, you might have to signal a waiver stating that you just perceive the dangers.5

Alternate options to Erythromycin Eye Ointment

Since gonorrhea is the commonest reason for ophthalmia neonatorum, a possible different to common prophylaxis can be screening all pregnant girls for gonorrhea and treating the mom, if contaminated, earlier than supply. At the moment, consultants suggest screening for gonorrhea for pregnant girls below 25 and pregnant girls at excessive danger for gonorrheal an infection. Nonetheless, not all pregnant girls obtain prenatal care, and those that don’t might have asymptomatic gonorrhea that will get handed to their infants throughout supply.5,18

Different alternate options, comparable to povidone-iodine, silver nitrate, and tetracycline antibiotic ointment, are now not accessible in the US. Another antibiotic ointment referred to as gentamicin could cause eye reactions from its administration.18

Throughout a latest erythromycin scarcity, the CDC really helpful {that a} weight-based dose of the antibiotic ceftriaxone be administered intravenously or intramuscularly to high-risk moms or these with no prenatal care.18

Finally, erythromycin eye ointment for newborns is low-risk and really efficient at stopping ophthalmia neonatorum and subsequent blindness in newborns. Nonetheless, if you’re assured that you just don’t have gonorrhea, it might be an pointless early intervention on your child. If you’re planning to ship in a hospital, you could not have a alternative of whether or not your child is given this drugs as a result of it will depend on your state.

If in case you have questions or considerations, it’s at all times finest to speak to your medical supplier or pediatrician however going into these conversations with some background is useful. By studying the aim, substances, unwanted side effects, and alternate options of erythromycin eye ointment, you might be one step nearer to creating an knowledgeable well being resolution on your new baby.


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