Understanding Newborn Antibiotic Eye Ointment

Welcoming a newborn into the world comes with a host of decisions that can significantly impact their health and well-being. Among these decisions is whether to use antibiotic eye ointment immediately after birth, a practice aimed at preventing neonatal conjunctivitis (ophthalmia neonatorum), a potentially severe eye infection.

This article explains the history, purpose, and effectiveness of using an antibiotic eye ointment and aims to help new parents make informed choices for their newborns.

What is Ophthalmia Neonatorum?

Ophthalmia Neonatorum (ON) is a significant eye infection in newborns, resulting from exposure to infectious agents during childbirth (1). It primarily affects the conjunctiva — the thin membrane covering the eyeball and inner eyelids — causing inflammation, redness, and discharge (1). This condition can be caused by various pathogens, with Neisseria gonorrhoeae and Chlamydia trachomatis being the most common bacterial culprits (1).

Neisseria gonorrhoeae, responsible for gonorrhea in adults, leads to Gonococcal Ophthalmia Neonatorum (GON), a severe form of the infection that can cause corneal scarring and blindness if left untreated (2). Similarly, Chlamydia trachomatis, the agent behind chlamydial infections in adults, can cause Chlamydial Ophthalmia Neonatorum (3), which, while generally less severe than GON, still poses significant risks to the infant’s eye health. 

Transmission of these bacteria to the newborn occurs as the baby passes through the birth canal of an infected mother. If a baby is born by C-Section and the mother’s membranes haven’t ruptured prior to birth, the baby is unlikely to come into contact with a pathogen that can cause ophthalmia neonatorum (4). 

While gonorrhea and chlamydia are common culprits and cause a more severe infection (1), ophthalmia neonatorum can also occur due to exposure to common bacteria like e. Coli or staph, or to viruses such as adenovirus or herpes simplex virus (1). 

What is Newborn Eye Ointment, and What is its Purpose?

Newborn eye ointment (erythromycin ophthalmic ointment), is an antibiotic eye ointment administered as a preventative measure against ophthalmia neonatorum. This ointment is applied to a newborn’s eyes shortly after birth as a standard care practice in the United States (5).

Erythromycin is considered very effective at its main function of preventing Gonococcal Ophthalmia Neonatorum (5), which can be severe and, if untreated, can cause blindness (6). There is some indication that erythromycin antibiotic eye ointment applied at birth may have a preventative action against neonatal conjunctivitis caused by other bacteria types like chlamydia and staph (7). However, more specific research shows that erythromycin isn’t very effective at preventing Chlamydial Ophthalmia Neonatorum (8) and may not be at all effective at preventing ophthalmia neonatorum stemming from other bacteria types (8). 

The Prevalence of STIs in Pregnant Women

Considering that newborn eye ointment works to prevent conjunctivitis caused by exposure to gonorrhea and/or chlamydia during birth, it is useful to consider the rates of gonorrhea and chlamydia in pregnant women in the U.S.

How Common is Chlamydia in Pregnant Women?

The prevalence of chlamydia among pregnant women varies by region, age, and socioeconomic status. However, the Centers for Disease Control and Prevention (CDC) estimates that only 1,843.9 out of every 100,000 birthing mothers were infected with chlamydia in 2018; that is just 1.8% of all pregnant women in the U.S. (9).

How Common is Gonorrhea in Pregnant Women?

The prevalence of gonorrhea in pregnant women is generally lower than that of chlamydia, with 2018 CDC data showing that 310.2 out of every 100,000 pregnant women are infected with chlamydia. That is 0.3% of pregnant women in the U.S. (9).

Gonorrhea and chlamydia are both easy to test for: In women this is usually done with a simple swab, and if a mother tests positive for either infection, the infection can be cleared with antibiotics.

Eye Goop as a Standard of Care

The practice of administering antibiotic eye ointment to newborns dates back to the late 19th century, initiated by the discovery that silver nitrate drops could prevent gonococcal ophthalmia neonatorum, a common cause of blindness in newborns at the time (10). As antibiotic treatments evolved, silver nitrate was largely replaced by antibiotic ointments, such as erythromycin, in the case of newborn eye care.

In the U.S. the application of antibiotic eye ointment is considered a standard of care, which means that eye ointment is applied to all babies born in a hospital setting, unless their parents request otherwise. In recent years, some experts have begun calling for a reevaluation of the use of newborn antibiotic eye ointment as a standard of care (10), due to its questionable effectiveness and the rise of resistance to macrolide — a class of antibiotics that includes erythromycin (10). 

Contrasting the U.S. approach, many European countries do not mandate the use of antibiotic eye ointment for all newborns (11). Instead, these countries often rely on comprehensive prenatal screening and treatment protocols for pregnant women, which effectively reduce the risk of transmitting Neisseria gonorrhoeae and Chlamydia trachomatis to newborns. This strategy reflects a more personalized approach that stands in contrast to the standard one-size-fits-all approach of administering antibiotics to all newborns in the U.S.

Risks Associated with Antibiotic Use in Newborns

While antibiotic eye ointment is generally considered safe for newborns, there are some risks and downsides associated with its use. These include the potential for allergic reactions, chemical conjunctivitis (12), and antibiotic resistance — of which its broader implications are a growing concern. Additionally, the application of ointment can cause temporary blurring of vision, which may interfere with early bonding experiences, such as breastfeeding and parent-baby visual interaction.

Moreover, the microbiome — the community of microorganisms living on and in the human body — begins to develop at birth. This includes the eye microbiome (13), which is likely disrupted by antibiotic ointment at birth, though this has yet to be studied. There is also some evidence that erythromycin eye ointment may be absorbed systemically and have an effect on gut motility and potentially the gut microbiome (14).

Can I Choose to Decline Antibiotic Eye Ointment for My Baby?

Yes, you can decline eye goop for your baby. It is recommendable to undergo STI testing to rule out infection prior to declining antibiotic eye ointment so that you can make an informed decision and weigh the risks and benefits of newborn eye ointment specific to your family’s situation.

My Baby Received Antibiotic Eye Ointment. Now What?

If your newborn received antibiotic eye ointment at birth, and you are concerned about the potential impact of the antibiotic on your baby’s microbiome, I want you to know that you are already an amazing parent for caring so much about your baby’s health. Getting plenty of skin to skin time (15), whether you are nursing or formula feeding, will encourage the development of a healthy microbiome. Additionally, there is evidence that taking probiotics after antibiotic use can help restore diversity to the microbiome (16). 

Summary

The purpose of applying an antibiotic eye ointment to newborns’ eyes soon after birth is to prevent an eye infection (Ophthalmia neonatorum) from occurring. Ophthalmia neonatorum occurs when a baby is exposed to Gonorrhea or Chlamydia while passing through the birth canal. The decision to use antibiotic eye ointment for newborns is one that involves weighing the benefits of preventing ophthalmia neonatorum against the risks of antibiotic use, including potential allergic reactions and impacts on the infant’s developing microbiome. While usage of antibiotic eye ointment is the standard of care in the U.S., it is important to know that you have the choice to decline this treatment for your infant. 

References:

1. Castro Ochoa KJ, Mendez MD. Ophthalmia Neonatorum. [Updated 2023 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551572/
2. CDC. (2021, July 14). Gonococcal Infections Among Neonates – STI Treatment Guidelines. Www.cdc.gov. https://www.cdc.gov/std/treatment-guidelines/gonorrhea-neonates.htm
3. Makker K, Nassar GN, Kaufman EJ. Neonatal Conjunctivitis. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441840/
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12. Auriti, C., Mondì, V., Aversa, S., Merazzi, D., Lozzi, S., Petroni, S., Baldascino, A., Massenzi, L., Bellù, R., Martinelli, S., & Mosca, F. (2021). OPHTHALMIA NEONATORUM in Italy: it is time for change. Italian journal of pediatrics, 47(1), 238. https://doi.org/10.1186/s13052-021-01186-2
13. Eye Medicine and Vitamin K Injection for Newborns. (n.d.). Www.nationwidechildrens.org. https://www.nationwidechildrens.org/conditions/health-library/eye-medicine-and-vitamin-k-injection-for-newborns
14. Ranjith, K., Sharma, S., & Shivaji, S. (2021). Microbes of the human eye: Microbiome, antimicrobial resistance and biofilm formation. Experimental eye research, 205, 108476. https://doi.org/10.1016/j.exer.2021.108476
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