Silver Nitrate and Prophylactic Eye Ointments for Newborns

What is it?

The application of silver nitrate or a similar antibiotic ointment such as tetracycline or erythromycin into the eyes of newborn babies just minutes after birth is another routine newborn procedure commonly performed in the United States.

Side Effects:

• Silver nitrate bonds with the eye membranes which results in redness, blurred vision, and swelling for several days.
• Early visual perception development is altered which impacts the baby's ability to adjust to the world outside the womb.

Why is it done?

The routine administration of eye ointment is required in most instances by state law on the grounds of preventing blindness from exposure to maternal gonorrhea during birth.

The glaring flaw in this logic is that STD screening is also standard procedure as part of prenatal care.  Even if a pregnant woman has screened negative for gonorrhea earlier in her pregnancy, the law assumes infidelity during pregnancy that will result in repeated exposure to STDs.

In addition, eye ointment doesn't have a 100% success rate in preventing blindness.  As a result, some hospital policies dictate injecting every newborn with penicillin at birth.  However, this practice helps breed antibiotic-resistant bacteria and puts the infant at risk of allergic reaction while in their most vulnerable state.

Simple Solutions

1.  Choose delayed administration.

• This will allow bonding time between you and your new baby without inflicting pain as one of the child's earliest sensory experiences.

2.  Request a non-irritating eye ointment, such as tetracycline.

• This allows the benefits of prevention without introducing the painful side effects.

3.  Refuse the procedure if it is not state law and you know you don't have an STD.

• If there are no risk factors, then administration has little to no benefit.

4.  Determine the penalty for refusal (sometimes a $5 fine) and refuse it then.

References

Bell TA, Grayston JT, Krohn MA, Kronmal RA, Eye Prophylaxis Study Group: Randomized trial of silver nitrate, erythromycin, and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis.  Pediatrics  92: 755-760, 1993  

Krohn MA, Hillier SL, Bell TA, Kronmal RA, Grayston JT, Eye Prophylaxis Study Group: The bacterial etiology of conjunctivitis in early infancy.  Am J Ophthalmol  138: 326-332, 1993

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Page Last Modified by Catherine Beier, MS, CBE