Eye Prophylaxis

What is neonatal eye prophylaxis?

Neonatal eye prophylaxis was introduced in the 1800s prior to the development of screening and treatment for gonorrhea and chlamydia. At the time, the practice of putting silver nitrate drops in the eyes of newborns greatly reduced the incidence of blindness as a complication of ophthalmia neonatorum caused by the transmission of gonorrhea and/or chlamydia to the baby at birth.

Now, improved laboratory testing and antibiotics to treat chlamydia and gonorrhea, the robust follow up care midwives and other health care professionals provide has led to very low rates of infection transmission. Research evidence does not support mandatory neonatal eye prophylaxis since the agents used for eye prophylaxis show high rates of ineffectiveness . Current practice in Ontario is for the mandatory administration of erythromycin ointment as a prophylactic agent into the eyes of all newborns to reduce the risk of blindness, unless the parent of the child opts out of the procedure.

Eye Prophylaxis Parental Opt-Out Form

 

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As of January 2019, parents can opt out of eye prophylaxis, providing they request to opt out in writing, that an informed choice discussion has been held with the health care provider, and that the health care provider determines there is no serious risk to the newborn. The AOM has created a template form that midwives may choose to use to document a parental opt out. This form supplements midwives' usual charting of eye prophylaxis informed choice discussions.

 

 

AOM Eye Prophylaxis Position Statement

 

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Both the AOM and the Canadian Paediatric Society have issued position statements to advocate for amendments to the Health Protection and Promotion Act to allow parents to decline neonatal eye prophylaxis for their newborns.