The Centers for Disease Control and Prevention, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the World Health Organization all recommend universal topical ocular prophylaxis to prevent gonococcal ophthalmia neonatorum. In the United States, ophthalmia neonatorum caused by N. gonorrhoeae has an incidence of 0.3 per 1000 live births, while Chlamydia trachomatis represents 8.2 of 1000 cases. However, this prophylaxis is not a uniform GLOBAL stance. The Canadian Pediatric Society recommends against universal prophylaxis. Several European countries, including Denmark, Norway, Sweden, and the United Kingdom, no longer require universal prophylaxis, instead opting for a prevention strategy of increased screening and treatment of pregnant women and/or selective use in those delivered without pregnancy screening. But WAIT… it gets even slightly more confusing. According to a 2022 publication from the FROM THE AMERICAN ACADEMY OF PEDIATRICS, the AAP has taken the position that the need for legal mandates for ocular prophylaxis should be reexamined and instead advocates for states to adopt strategies to prevent ophthalmia neonatorum by focusing on maternal treatment, such as compliance with CDC recommendations for prenatal screening and treatment of N gonorrheae and Chlamydia trachomatis. This was also the subject of a recent review published May 2023 in an article titled, “Neonatal ocular prophylaxis in the United States: is it still necessary?”. Confused...don't be. We’ll cover all this information in this episode. So, can erythromycin ophthalmic application be avoided in some cases? Is that safe? And if so, doesn’t that conflict with current US neonatal care expectations? Listen in and find out.
Dr. Chapa’s Clinical Pearls.