Neonatal eye prophylaxis: Nursing pharmacology

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.