Bulletin No. 9
May 16, 1980
Prophylaxis for gonococcal ophthalmia neonatorum

The National Society for the Prevention of Blindness and the American Academy of Pediatrics have stated in recent years that infants' eyes should not be irrigated after instillation of 1% silver nitrate (AgNO₃). The package insert from the drug manufacturer also states that irrigation (usually done with normal saline or distilled water) is not recommended.

The chemical conjunctivitis caused by AgNO₃ drops is self-limiting, usually resolving within 24-48 hours. It is less severe if the drops are stored in individual wax ampules. This procedure minimizes evaporation, which would increase the concentration of the solution.

CDC's gonorrhea treatment recommendations include the use of AgNO₃ without saline rinse for all newborn infants. AgNO₃ prophylaxis appears to be more effective in preventing gonococcal ophthalmia neonatorum (GC-ON) than saline eye washings or no prophylaxis. AgNO₃ prophylaxis is not 100% effective, however, as shown in 1 study of 46 cases of gonococcal ophthalmia which occurred in spite of some form of AgNO₃ prophylaxis. Nevertheless, according to that study the risk of GC-ON developing in an infant born to an infected mother was less than 2% when AgNO₃ was used.

The occurrence of GC-ON in spite of the use of AgNO₃ may be caused by several factors: (1) improper application, (2) washing with water or saline, (3) silver cation precipitation by saline to form silver chloride crystals, (4) infection of the eyes before delivery because of premature rupture of the membranes in an infected woman, and (5) failure to treat an infected mother with subsequent transmission to her infant after the delivery.

In addition to proper instillation of AgNO₃ without rinsing, other measures are essential in preventing GC-ON, including: (1) prenatal screening of pregnant women at their initial visits and before delivery, (2) appropriate evaluation of all neonatal conjunctival discharges with Gram stain and culture, and (3) continuing education for obstetric and pediatric personnel who will be required to diagnose and manage this complication.

NEW STATE REGULATIONS

The following regulations became effective May 3, 1980, and require prophylactic treatment of newborns' eyes to prevent Gonococcal Ophthalmia Neonatorum.

7 AAC 27.111. PROPHYLACTIC TREATMENT OF NEWBORNS' EYES.

1. Each infant born in Alaska must have administered to him or her by a physician, nurse, or certified midwife, one of the following prophylactic measures within one hour after birth onto the inside surface of the infant's lower eyelids."
   1. one percent silver nitrate solution dispensed from individual wax ampules and allowed to remain in place without irrigation;
   2. tetracycline ophthalmic ointment; or
   3. erythromycin ophthalmic ointment.
2. Prophylaxis is not required:
   1. if the infant is receiving parenteral antibiotics; or
   2. if the infant's delivery occurs at an unplanned time when prophylactic measures are unavailable.
3. A physician, nurse, or certified midwife who detects gonorrhea infection of the eye in a newborn infant shall report the infant's name, birthdate, extent of infection, and place of residence to the Communicable Disease Control Section of the Department of Health and Social Services. (Eff: 5/3/80, Reg 74)

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