The US Preventive Services Task Force examines if treatment for a potential newborn eye infection is still necessary today.
A long history of blindness in children worldwide exists due to newborn pink eye, or a newborn eye infection. Sexually transmitted diseases in the mother cause most of these eye infections, which present as red, goopy eyes. One specific sexually transmitted infection, gonorrhea, can lead to one of the most devastating eye infections. A newborn eye infection from gonorrhea can cause blindness, eye scars, and a hole in the eye as soon as 24 hours after birth.
The US Preventive Services Task Force (USPSTF) periodically reviews its clinical recommendations for treating patients without signs and symptoms of a disease. The USPSTF recently reexamined its 2011 recommendation that all newborns should be treated with an eye medication to prevent a newborn eye infection from gonorrhea.
In the late 1800s, doctors diagnosed a newborn eye infection in about 10% of newborns born in European hospitals, where 3% of these infections resulted in blindness. The origin was unknown until 1879 when Albert Neisser, a German physician, determined the cause was gonorrhea in the mother. In 1880, another German physician, Carl Credé, began using a silver nitrate treatment to prevent newborn eye infections. This treatment was highly successful but was very irritating to the eyes.
Doctors prevent most newborn eye infections with antibiotics
In the US today, doctors prevent most newborn eye infections by administering antibiotics to pregnant women with sexually transmitted diseases and all newborns. Erythromycin, an antibiotic, is the only medication approved by the US Food and Drug Administration for the prevention of newborn eye infection from gonorrhea. Standard-of-care is for doctors to apply erythromycin ointment to the eyes of every newborn immediately after birth to prevent an eye infection.
The USPSTF chose to reexamine its 2011 recommendation by using a process reserved for well-established standard-of-care practices. With this process, strong, opposing evidence is required to change the previous recommendation.
Reports estimated that from 2013 to 2017, the number of newborns in the US with a newborn eye infection from gonorrhea was roughly less than one per 100 000 births. In addition, erythromycin ointment does not cause serious harm to the newborn. Importantly, if not pre-treated, the chance of a newborn contracting gonorrhea from its mother is 30% to 50%.
The USPSTF will uphold their recommendations
The above findings combined with no new opposing evidence led the USPSTF to uphold its recommendation. Published in JAMA, the USPSTF reaffirmed that treating all newborns with an eye medication is highly effective at preventing a newborn eye infection from gonorrhea.
However, additional research is needed to determine if gonorrhea has developed resistance to erythromycin ointment in the US. In other countries, antibiotic resistance has been found, and thus alternative treatments to erythromycin need to be discovered.
Canada and many European countries do not support medicating all newborns against possible eye infection
The USPSTF upholds its approach to treat all newborns due to a lack of tools to determine the risk of gonorrhea in newborns, as well as a lack of studies comparing treating at-risk newborns versus all newborns. This approach to treat all newborns is also supported by the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, Centers for Disease Control and Prevention, and the World Health Organization.
In contrast, the Canadian Pediatric Society and several European countries do not support treating all newborns but promote screening and treatment of pregnant women for gonorrhea.
In conclusion, the USPSTF confirmed its previous recommendation that an eye medication for every newborn is greatly beneficial in the prevention of a newborn eye infection from gonorrhea.
Written by Mindy Nash, O.D.
References:
- US Preventive Services Task Force. Ocular prophylaxis for gonococcal ophthalmia neonatorum: US Preventive Services Task Force reaffirmation recommendation statement. JAMA.2019;321(4):394–398. doi:10.1001/jama.2018.21367.
- Centers for Disease Control and Prevention (CDC). 2015 sexually transmitted diseases treatment guidelines. CDC website. https://www.cdc.gov/std/tg2015/default.htm. Updated January 25, 2017. Accessed February 8, 2019.
- Dekker R. The evidence on: erythromycin eye ointment for newborns. Evidence Based Birth Web site. https://evidencebasedbirth.com/is-erythromycin-eye-ointment-always-necessary-for-newborns/. Updated August 3, 2017. Accessed February 8, 2019.
