Why do Hospitals use Eye Ointment on Newborns?
Hi, everyone! In this Q&A video, we’re going to talk about why so many hospitals put ointment in babies’ eyes after they’re born. Today we’re going to talk all about eye ointment for newborns. This is one of three, free videos all about vitamin K and eye ointment for newborns. If you haven’t subscribed yet to the emails that go along with the video lessons, make sure you do. We’ll put the link below.
I released these three free video lessons in the year 2014 to celebrate the launch of a class I created for maternity care professionals all about vitamin K and eye ointment. This video was originally recorded in 2014 and today I’m updating it in 2020.
So here’s the deal.
Around the world, there’s a lot of variation between countries with regards to whether or not they routinely give eye ointment to all newborns. For example, I eye ointment is recommended for all newborns in Brazil, France, Italy, Slovenia, Spain and Turkey. However, eye ointment is not routinely done in most European countries, including England, and it’s not done in Australia. In Canada, their pediatrician organization recently put out a statement saying that Canada should get rid of the laws that require mandatory eye ointment for all babies, and instead use the same screening and treatment method that is used in other countries. In the United States, there is a lot of debate about giving eye ointment to all newborns here.
The US Preventative Services Task Force released a statement in 2019 reaffirming its earlier recommendation from 2011 to give all newborns the eye ointment. However, the American Academy of Pediatrics no longer recommends universal usage of eye ointment in their 2018 Redbook. They call for reevaluating state mandates and they opt for a prevention strategy that includes increased screening and treatment for gonorrhea. But they do say that routine eye ointment is still appropriate in some areas where gonorrhea is widespread and there are low rates of screening and treatment for gonorrhea.
People outside of US see pictures of our newborn babies in America and they say what’s that weird goofy stuff in their eyes? Seriously, they think we’re crazy.
So why do US hospitals put ointment in babies’ eyes?
Well, the ointment is a topical antibiotic called erythromycin and it’s supposed to prevent an eye infection from gonorrhea and chlamydia called, this is a really intimidating word but this is the big word that’s used, ophthalmia neonatorum, which basically means pinkeye in a newborn. Now, all of you watching this video have probably had pinkeye at some point in your life. Pinkeye or conjunctivitis is inflammation of the lining of the eye and it can be caused by viruses, bacteria, irritation or chemicals. Most of the time pinkeye is pretty benign, even though it’s uncomfortable. But it’s not usually a big deal. It’s easily treatable and in many cases, like with viruses, it goes away on its own. The problem with pinkeye is that if a baby contracts gonorrhea from their mother during birth, which is a sexually transmitted infection, then this can cause a dangerous type of pinkeye. This dangerous type of pinkeye, if left untreated, can cause blindness in about 3% of babies who are affected.
The Centers for Disease Control in the United States said that in 2017, young adult women have the highest rates of gonorrhea, with rates between six to nine cases per 1000 women. These rates may be higher or lower in other countries. Much of the time, gonorrhea infections do not show any symptoms. So it’s quite possible to be infected and not know it. Now, let’s rewind a little bit to the late 1800s. More than 100 years ago, in 1880, a doctor named Dr. Crede discovered that if he put silver nitrate ointment in the eyes of newborns, he could prevent nearly 100% of cases of blindness from pinkeye in newborns. This was a pretty big discovery at that time, but let’s think for a minute. What’s different about the year 1880 compared to today?
Well, number one, up until the 1940s, they didn’t even have any antibiotics. So if a baby developed dangerous pinkeye from gonorrhea, they couldn’t treat it. The infection would just rage on, potentially causing blindness. Number two, they didn’t really have the ability to screen for gonorrhea.
Many mothers had gonorrhea back then. It was much more common than it is today. Plus, because women with gonorrhea often don’t have any symptoms, this meant that mothers with gonorrhea could give birth to their babies and pass on the infection to the baby without knowing it. In fact, back in 1880, one in 10 babies caught gonorrhea from their mothers during birth. Because we didn’t have antibiotics, we couldn’t treat the mothers and we couldn’t treat the babies. The infection was everywhere. It was crazy. A third reason 1880 was different from today is because that they eventually realized that silver nitrate was really, really painful. So once antibiotics were developed, they switched from silver nitrate to erythromycin. This is a small tube that has erythromycin eye ointment in it and you can see that it’s pretty small. It’s fairly cheap, inexpensive. It’s just a little gel that they put directly in the lining of the baby’s eye. So you can see I’m squeezing the gel out right here, and it’s just this kinda clear cloudy gel that they would squirt in the lining of the baby’s eye. Erythromycin eye ointment might be a little uncomfortable. It can cause some temporary blurred vision once it’s applied, but it’s not painful like the silver nitrate was.
The problem is about one in four cases of gonorrhea is now resistant to erythromycin. Because of that, a lot of countries have switched to something called povidone-iodine, which is a disinfectant eyedrop that’s much cheaper and possibly more effective than a erythromycin. However, povidone-iodine eyedrops are not available in the United States. So increasing antibiotic resistance is part of the reason why people in England, Australia, and so many other countries don’t use eye ointment in babies anymore. With adequate prenatal care, there’s really no need to use the ointment in every baby. And instead of giving eye ointment to all babies, they’re screening all pregnant people for gonorrhea and treating them if necessary to rid them of the infection, and then the partners are also being treated, so that they can avoid reinfecting the mother.
Another reason why so many countries don’t use eye ointment anymore is because they can treat the babies’ eyes if they do develop an infection. When there is easy access to healthcare such as with universal healthcare, it is less likely that infections will go untreated and cause harm. On the other hand, some countries or regions within countries may still benefit from using the eye ointment or the povidone-iodine. The eye ointment is helpful when there are higher rates of gonorrhea and when pregnant people are less likely to get screened or treated because they don’t have access to prenatal care. So if someone’s not getting access to prenatal care, then the screen and treat method won’t work for them. In that case, the eye ointment would be the better choice. In fact, one of the main reasons that the US Preventive Services Task Force reaffirmed their 2011 recommendation to give all newborns eye ointment is because many pregnant people in the US still lack prenatal care. Overall, in the year 2016, an estimated 6% of pregnant people in the US received little or no prenatal care, and the rate was as high as 20% in some locations within the US. So that’s it for today’s video.
If you’d like to learn more, including the pros and cons of the ointment and whether or not it can work to prevent other eye infections such as those caused by staff infections, I’d like to encourage you to visit our evidence-based birth signature article, all about the evidence on eye ointment in newborns. Also, if you end up, after talking with your care provider, deciding to decline the eye ointment, make sure you check the laws in your state. Some states in the United States require mandatory eye ointment for all newborns. Yes, it may sound crazy but it’s true. Some awesome birth professionals and parents have actually joined together to get some of these laws reversed. I’ll post a few links in the show notes to give you some examples of how they got laws changed their states. That’s it for now. Thanks and I hope this was helpful. Bye. To learn more and subscribe to our newsletters for useful information, please visit EvidenceBasedBirth.com.