Neonatal eye prophylaxis: Nursing pharmacology

Neonatal eye prophylaxis refers to the use of medication to prevent ophthalmia neonorum, which is an eye infection that is most commonly caused by neisseria gonorrhea 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 neonorum 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 gonorrhea are notorious for their ability to creep onto the cornea, resulting in blindness.

So, neonatal eye prophylaxis is mostly aimed at preventing gonococcal ophthalmia neonorum. Now, in the past, neonatal eye prophylaxis involved the use of the chemical silver nitrate.

Ironically, it was later discovered that silver nitrate itself actually also damages the conjunctiva, resulting in chemical conjunctivitis.

Currently, the primary medication used in neonatal eye prophylaxis for neisseria gonorrhea 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.

OK, 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 not to wipe away the ointment to allow for absorption.

Now, before administering the ointment, assess the baby's eyes for any redness, edema, or drainage. Then, clean each eye with a separate piece of sterile cotton or soft gauze by wiping from the inner canthus to the outer canthus.

If there is a lot of drainage or crusting, obtain a specimen, and then cleanse the eyes with sterile saline. Afterwards, obtain an order from the pediatrician to send the specimen to the lab for culture.

Next, gently draw down the skin below the eye to expose the lower conjunctival sac, and apply a 1 centimeter ribbon of erythromycin ophthalmic ointment along the lower lid margin of each eye.

You may need to dim the lights to prevent any discomfort the baby may experience as a result of the glare from the bright lights.

For premature babies whose eyes may still be fused, apply the ointment along the line of fusion. During administration, be sure to avoid touching the applicator tip with your hands, the newborn's eyes, or any other surface.

After administration, gently close the eyes for 30 to 60 seconds. Wipe away any excess ointment around the periorbital skin, but don't flush or wipe away the ointment from the eyes.

As you continue to care for the newborn, monitor for signs of hypersensitivity or an allergic reaction. All right, as a quick recap, neonatal eye prophylaxis prevents ophthalmia neonorum, an eye infection most typically caused by neisseria gonorrhea, that can be transmitted while in utero or during vaginal delivery.

Ophthalmia neonorum can lead to blindness if left untreated. So ophthalmic erythromycin is used prophylactically for all newborns within one hour of birth.

Ophthalmic erythromycin is a macrolide antibiotic ointment that works by inhibiting bacterial protein synthesis. Side effects are rare and include eye irritation, redness, or hypersensitivity.

Nursing considerations include ensuring informed consent is obtained, educating parents or guardians, using proper administration technique, and ongoing monitoring and care.