Tuesday, September 30, 2014

Neonatal Ocular Prophylaxis: Is it Necessary or Effective?

According to medical studies, no.  Below you will find studies which prove that the eye ointment routinely applied to newborns does not significantly alter eye infections as opposed to no ointment of any kind.  Also, there is evidence that the bacteria which cause these infections are not passed to the infant in the birth canal, but after birth.  Also, it has been found that a significant number of infants develop an infection even though they HAVE received the ointment. Read for yourself.

Bell TA, Grayston JT, Krohn MA, Kronmal RA.  Randomized trial of silver nitrate, erythromycin, and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis.  Pediatrics 1993 Dec;92(6):755-60.

Eye Prophylaxis Study Group.  Department of Biostatistics, University of Washington, Seattle 98195.  OBJECTIVE. To compare the efficacy of commonly used forms of eye prophylaxis for newborns with no prophylaxis in the prevention of nongonococcal conjunctivitis. The results suggest that parental choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy.

Chen JY.    Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis.  Pediatr Infect Dis J 1992 Dec;11(12):1026-30.

The incidence rates of neonatal chlamydial conjunctivitis in the tetracycline, erythromycin, silver nitrate, no prophylaxis and erythromycin twice groups were 1.3, 1.5, 1.7, 1.6 and 1.4%, respectively. We conclude that neonatal ocular prophylaxis with erythromycin (one or two doses) or tetracycline or silver nitrate does not significantly reduce the incidence of neonatal chlamydial conjunctivitis compared with that in those given no prophylaxis.

Krohn MA, Hillier SL, Bell TA, Kronmal RA, Grayston JT.  The bacterial etiology of conjunctivitis in early infancy.  5: Am J Epidemiol 1993 Sep 1;138(5):326-32.

The findings concerning the species of bacteria most often associated with conjunctivitis, as well as the finding that method of delivery is unimportant, suggest that bacteria were transmitted to the infants' eyes after birth and not from the birth canal.

Black-Payne C, Bocchini JA Jr, Cedotal C.  Failure of erythromycin ointment for postnatal ocular prophylaxis of chlamydial conjunctivitis.  14: Pediatr Infect Dis J 1989 Aug;8(8):491-5.

The conclusion was that a substantial percentage of infants exposed to Chlamydia develop chlamydial conjunctivitis despite receiving erythromycin ocular prophylaxis.

I feel inclined to ask, if the infants are contracting the bacteria after birth and not in the birth canal, where is it coming from?  In the hospital, bacteria is rampant, and even the chemical sterilizing agents used to clean hospitals have been shown to be ineffective in totally wiping out bacteria.  It is hard for me to believe that it was introduced to the infants by the mothers after birth;  the baby makes it through the birth canal, with the mother's bodily fluids smeared all over it, and still comes out without an infection, only to be introduced to it from normal handling by the mother?  I don't think so.  I can only conclude it was introduced by the handling of hospital personnel.

Another good reason for home birth, where your baby is already immune to the germs in the environment it is born into.

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