Interventions for preventing ophthalmia neonatorum

Kapoor, Vimal; Evans, Jennifer R; Vedula, Satyanarayana S

doi:10.1002/14651858.cd001862.pub4

Cited by 18 publications

(20 citation statements)

References 139 publications

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“…Of 24 infants that received tetracycline prophylaxis, 11 tested positive for chlamydial ophthalmia neonatorum, including both confirmed and probable cases of infection. The cases reported in our study reinforce that tetracycline prophylaxis is not effective at preventing chlamydial ophthalmia neonatorum, and helps clarify findings from a recent Cochrane review 44 which had suggested, with low certainty, some efficacy for tetracycline. All but one infant had received the standard ocular tetracycline prophylaxis at birth.…”

Section: Discussionsupporting

confidence: 77%

“…39 However, while those agents have been shown to be effective for preventing ophthalmia neonatorum from N. gonorrhoeae, there is no antimicrobial agent that has been shown to reliably prevent ophthalmia neonatorum resulting from C. trachomatis. 12,43 In a recently published Cochrane review to determine optimal prophylactic regimens, 44 the authors summarized evidence from 30 trials, only 4 of which were carried out in African countries (Angola, Kenya, and Zaire). Using blindness (or other adverse visual outcomes) or conjunctivitis at 1 month, the authors reported that compared to no prophylaxis, any of tetracycline, erythromycin, povidone iodine, or silver nitrate had very limited effect (0.96, 95% CI 0.57-1.61) on the risk of chlamydial ophthalmia neonatorum.…”

Section: Preventionmentioning

confidence: 99%

“…None of these findings were statistically significant and the authors judged the overall evidence as insufficient and of low certainty. 44 Smith-Norowitz et al, 45 from a similarly themed systematic review, analyzed evidence from 3 eligible studies, all carried out in the United States, and concluded that neither erythromycin nor tetracycline were efficacious in preventing chlamydial ophthalmia neonatorum.…”

Section: Preventionmentioning

confidence: 99%

“…In a recently published Cochrane review to determine optimal prophylactic regimens, 44 the authors summarized evidence from 30 trials, only 4 of which were carried out in African countries (Angola, Kenya, and Zaire). Using blindness (or other adverse visual outcomes) or conjunctivitis at 1 month, the authors reported that compared to no prophylaxis, any of tetracycline, erythromycin, povidone iodine, or silver nitrate had very limited effect (0.96, 95% CI 0.57–1.61) on the risk of chlamydial ophthalmia neonatorum.…”

Section: Evidence Reviewmentioning

confidence: 99%

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Case series and literature review of chlamydial ophthalmia neonatorum in Botswana

et al. 2023

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Background We describe 12 cases of chlamydial ophthalmia neonatorum and the current scientific evidence on its prevention and treatment. The data presented were obtained from the “Maduo” study, a prospective observational study of the relationship between curable sexually transmitted infections and adverse neonatal outcomes at four antenatal clinics in Gaborone, Botswana. Methods Infants of mothers with perinatal chlamydia infection were evaluated for chlamydial ophthalmia neonatorum based on clinical presentation of conjunctivitis or positive test via GeneXpert CT/NG assay. Data on 29 infants born to mothers with postnatal C. trachomatis infection were analysed. Results 12 infants were diagnosed with chlamydial ophthalmia neonatorum. Eight of those cases were confirmed with the GeneXpert CT/NG assay while four were identified as probable cases based on clinical history and presentation. Overall, nine infants presented with signs of conjunctivitis, while three who had a positive diagnostic test result had asymptomatic infection. All but one infant had received ocular 1% tetracycline prophylaxis at birth, and four infants had signs suggestive of chlamydial pneumonia at presentation. Two out of five symptomatic cases whose mothers reported completion of their treatment course with erythromycin had lingering symptoms. Conclusions Our findings affirm that the current prophylaxis and treatment modalities for chlamydial ophthalmia neonatorum are inadequate. To the extent feasible in low- and middle-income countries, we recommend implementation of routine C. trachomatis screening and treatment in pregnant women.

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Section: Discussionsupporting

confidence: 77%

Section: Preventionmentioning

confidence: 99%

Section: Preventionmentioning

confidence: 99%

Section: Evidence Reviewmentioning

confidence: 99%

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Case series and literature review of chlamydial ophthalmia neonatorum in Botswana

et al. 2023

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“…The infection, usually contracted from the mother’s infected birth canal during vaginal delivery, can cause corneal damage and vision loss. In the past, the term mainly defined conjunctival infections caused by Chlamydia trachomatis and Neisseria gonorrhea , which are the pathogens most frequently responsible for permanent ocular damage [ 1 , 2 ]; currently, ON also defines neonatal conjunctivitis caused by other bacteria [ 3 ]. The incidence of ON by N. gonorrhoeae has significantly decreased with the widespread use of conjunctival antibacterial prophylaxis with 2% silver nitrate, introduced by Karl Franz Credè in Germany at the end of the 19th century [ 2 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Intersociety Position Statement on the Prevention of Ophthalmia Neonatorum in Italy

Tzialla,

Auriti,

Aversa

et al. 2023

Microorganisms

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There is currently no worldwide agreement on the real need to administer conjunctival antibiotics to neonates at birth to prevent neonatal conjunctivitis (usually defined as ophthalmia neonatorum) by Chlamydia trachomatis and Neisseria gonorrhoeae. Therefore, there is wide variability in antibiotic administration, conditioned mainly by the social and health context. In Italy, a law enacted in 1940 required doctors and midwives to administer ophthalmic prophylaxis with 2% silver nitrate to all newborns at birth. This law was repealed in 1975 and since then there has been no clear guidance on the use of ophthalmia neonatorum prophylaxis at birth. Since neonatal conjunctivitis caused by C. trachomatis and N. gonorrhoeae is not reported, we carried out a nationwide survey of 1,041,384 neonates across all Italian birth centers to evaluate the incidence of ophthalmia neonatorum and the current practice of prophylaxis. After analyzing the results, we formulated an intersociety position statement on the prevention of ophthalmia neonatorum to update and standardize this prevention strategy in Italy.

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