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Neonatal eye prophylaxis: Nursing Pharmacology

Notes

Notes

NEONATAL EYE PROPHYLAXIS
DRUG NAME
erythromycin
CLASS
Macrolide antibiotic
MECHANISM OF ACTION
Binds to and blocks the 50S subunit of bacterial ribosomes to inhibit protein synthesis, thereby stopping bacterial growth and replication
INDICATIONS
Neonatal eye prophylaxis for prevention of gonococcal ophthalmia neonatorum
ROUTE(S) OF ADMINISTRATION
Topical eye ointment / ophthalmic route
SIDE EFFECTS
Mild eye irritation, redness, and hypersensitivity
CONTRAINDICATIONS AND CAUTIONS
N/A
NURSING CONSIDERATIONS
Assessment and monitoring
  • Ensure informed consent
  • Assess eyes for drainage or crusting
  • Monitor for side effects after administration

Administration
  • Administer within one hour after delivery
  • Clean eyes prior to administration
  • Apply 1 cm ribbon of ointment to the lower conjunctival sac of each eye
    • Inner to outer canthus
  • Avoid contamination of applicator tip
  • Close the eyes for 30–60 seconds
  • Wipe away any excess ointment around the periorbital skin

Client education
  • Purpose of medication
  • Potential side effects
  • Avoid wiping away ointment
Transcript

Neonatal eye prophylaxis refers to the use of medication to prevent ophthalmia neonatorum, which is an eye infection that is most commonly caused by Neisseria gonorrhoeae or Chlamydia trachomatis.

These bacteria are usually transmitted during vaginal delivery as the baby passes down an infected birth canal, but intrauterine infection of the fetus may also occur after rupture of membranes.

Now, ophthalmia neonatorum typically presents as conjunctivitis, with eye redness, edema, and purulent discharge within 2 to 5 days of life, and while some infections can be mild, untreated infections with Neisseria gonorrhoeae are notorious for their ability to creep onto the cornea, resulting in blindness. So, neonatal eye prophylaxis is mostly aimed at preventing gonococcal ophthalmia neonatorum.

Now, in the past, neonatal eye prophylaxis involved the use of the chemical silver nitrate. Ironically, it was later discovered that silver nitrate itself damaged the conjunctiva, resulting in chemical conjunctivitis.

Currently, the primary medication used in neonatal eye prophylaxis for Neisseria gonorrhoeae is erythromycin, which is a macrolide antibiotic, and is given to all newborns in the form of an ophthalmic ointment within the first hour of life.

Now, once administered, erythromycin acts by entering into the bacterial cell and binding to the 50S subunit of bacterial ribosomes. As a result, the ribosome is stopped in its tracks and the synthesis of proteins is inhibited. The absence of necessary proteins prevents the bacterial cell from growing and replicating.

Ophthalmic erythromycin administration is rarely associated with side effects, which include mild eye irritation and redness.

Okay, ophthalmic erythromycin is administered within one hour after birth to allow time for bonding and breastfeeding. Before administration, be sure to confirm that informed consent has been obtained from the baby’s parents or guardians.

Reassure them that the medication is a standard of care for all newborns, that the application of ophthalmic erythromycin is not painful, and that the few side effects include mild redness and irritation.

Explain how it’s normal for the newborn’s eyes to appear a little red, swollen, or cloudy after administration; and instruct them to not wipe away the ointment to allow for absorption.

Sources
  1. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2019)
  2. "Pearson Reviews & Rationales: Comprehensive Review for NCLEX-RN, 3rd Edition" Pearson (2018)
  3. "Prevention of Neonatal Ophthalmia" Red Book (2021)
  4. "Neonatal conjunctivitis (Ophthalmia Neonatorum)"  (2021)
  5. "Treatment and prevention of ophthalmia neonatorum"  (2013)
  6. "Ophthalmia neonatorum"  ()
  7. "Eye Prophylaxis/Vitamin K Injection"  ()
  8. "Pharmacology" Elsevier Health Sciences (2014)
  9. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)