👁️ ANTIBIOTIC EYE OINTMENT 👁️ - why do newborns routinely get antibiotic eye ointment (erythromycin, in Canada) placed in their eyes within 1-2 hours after birth?
ON (ophthalmia neonatorum) is essentially an eye infection in babies which can be caused by different bacteria or viruses; most notably Gonorrhea, which accounts for about 1% of ON cases in Canada. 40% of ON cases in Canada are caused by chlamydia, the remaining 59% of cases are caused by other viruses, bacteria, and even chemicals. Gonorrheal ON is particularly noteworthy, as it can evolve into severe eye damage and permanent blindness. Pretty scary, right?
In 1880, Dr. Crede, a physician in Germany, discovered that putting silver nitrate in newborns' eyes significantly reduced the incidence of childhood blindness. A pretty big discovery! It quickly became routine practice in developed countries to apply antibiotics to newborns' eyes. Fastforwarding 140 years to today though, lots of things have changed.
👁️ Gonorrhea was rampant, significantly moreso than it is today, again, because there were no antibiotics to treat people who had gonorrhea. So infected people passed the infection on and it spread quickly and widely.
👁️ There was no screening test for gonorrhea. So approximately 10% of all babies born in 1880 actually contracted gonorrhea from their mothers at birth! Today women routinely get tested for chlamydia/gonorrhea during pregnancy and then treated if positive to prevent transmission to the baby at birth.
👁️ Antibiotics for gonorrhea were developed in 1935, so now if a pregnant person tests positive, they can quickly and easily be treated with antibiotics (that are safe for the baby). If a neonate contracts gonorrheal ON from their mother, they can be treated with antibiotics too. Yay!
👁️ We discovered that silver nitrate hurts. A lot. Canada offers erythromycin eye ointment which is uncomfortable but isn't painful like silver nitrate. However, about 25% of gonorrheal strains are now RESISTANT to erythromycin, likely due in part to indiscriminate overuse in every newborn.
In 2015, the Canadian Pediatric Society released a position statement recommending that Canada revise its routine administration of erythromycin and move towards preventative care instead (screening pregnant persons, treating positive cases, carefully monitoring infants for signs of infection). But 5 years later, we are still routinely administering antibiotics to every. single. newborn.
It is still recommended to provide antibiotic eye treatment to newborns at birth if they are born to a mother who had little or no prenatal care (unaware of gonorrhea status) or has a high risk lifestyle (multiple casual sex partners, unprotected sex, etc).
BOTTOM LINE: In Alberta, and in many developed countries around the world, your newborn will receive antibiotic eye ointment unless you clearly verbally refuse it, despite a lack of evidence to support this procedure.
Are you expecting a new baby in 2020? What do you think about the routine practice of putting antibiotic eye ointment in every newborn's eyes?
RESOURCES:
https://evidencebasedbirth.com/is-erythromycin-eye-ointment-always-necessary-for-newborns/
https://www.cps.ca/en/documents/position/ophthalmia-neonatorum