One question new parents often ask me about navigating newborn care in the hospital is whether it’s necessary to administer erythromycin eye ointment to their babies. Can you refuse newborn eye ointment? Well, that decision is a balance between risk and benefit. As a medically-minded RN and a naturally-minded mom of 7, here’s my take on it:

What is Newborn Eye Ointment

Erythromycin eye ointment is an antibiotic ointment that a nurse will apply to your newborn’s eyes shortly after birth. Its purpose is to prevent bacterial infections that can lead to ophthalmia neonatorum (ON), an eye infection that can result in blindness if untreated. The most common bacteria it protects against are those sexually transmitted infections (STI) that can be transmitted during childbirth, particularly from untreated chlamydia or gonorrhea infections in the mother (4).

When is the Newborn Eye Ointment Given?

Erythromycin eye ointment is typically given within the first hour after birth, and at least within the first 24 hours. The timing is important for babies with exposure to chlamydia or gonorrhea, as early treatment maximizes the ointment’s effectiveness in preventing the transmission of the infection to baby’s eyes. Most often, nurses will administer the ointment during physical examination of the baby directly after birth (1).

What’s the Procedure for Giving the Newborn Eye Ointment?

1. Preparation: The baby’s eyes are gently cleaned.
2. Application: The lower eyelid is gently pulled outward and a small ribbon of ointment, about 1 centimeter long, is squeezed into the space between the eyelid and the eyeball.
3. Monitoring: The ointment may cause temporary blurriness in the baby’s vision, but it typically does not cause discomfort. The nurse will monitor the baby for any signs of an allergic reaction or irritation, though these are rare (3).

The Risks and Benefits of Newborn Eye Ointment & Can I Refuse It

Benefits of Erythromycin Eye Ointment for Newborns:

The routine use of erythromycin eye ointment in newborns is a preventive measure to prevent infection and blindness in babies whose moms have either an undiagnosed or untreated STI. And for moms who do have an STI, erythromycin eye ointment has been shown to reduce the rate of chlamydial ON by 68%-77% (6). It could also potentially protect against other bacteria in the vagina, such as staph, from entering the baby’s eyes–however, this isn’t conclusive.

The Risks of Eye Ointment for Newborns:

One common objection to newborn eye ointment, which has the consistency of Vaseline, is that it blurs baby’s vision. While this is temporary, it has the potential to impeded bonding and that early eye contact between you and your newborn. And, it could make the baby fussy, also impacting early bonding.

(NOTE!!! If you are planning to use the ointment but are low-risk for an STI and feel comfortable waiting, you can ask the nurses to delay administering eye ointment until after the “golden hour” is finished. This will give you time for early breastfeeding and skin-to-skin, without any vision impairment.)

Though considered rare, one risk of erythromycin eye ointment is chemical conjunctivitis, which can result in discomfort for the baby, swelling, and eye discharge (3).

And some feel that the early exposure to antibiotics can impact the baby’s biome. While this may be true, the effect of the eye ointment is localized and not systemic. This means that any impact your baby’s overall microbiome would be very limited.

Making an Informed Decision

Who Might Be a Good Candidate to Refuse Newborn Eye Ointment?

1. Low-Risk Parents: If you have had STI testing early on in pregnancy and again in the 3rd trimester, and you and your partner have a very low risk of contracting an STI (long-term, monogamous relationship)
2. Informed Choice: Parents who are fully informed about the risks and benefits and feel confident in their decision to refuse the treatment.
3. Alternate Plans: Those who have discussed alternative monitoring and treatment plans with their doctor in case of signs of infection.

The Protocol for Refusal of Newborn Eye Ointment

Many states have laws that require eye ointment to newborns as a standard part of care after birth. If you choose to refuse eye ointment for your baby, talk with your doctor beforehand and familiarize yourself with the laws in your state.

1. Discuss with Your Healthcare Provider: It’s crucial to have an open and honest discussion with your healthcare provider during your prenatal visits. Discuss your concerns and understand the risks and benefits thoroughly.
2. Document Your Decision: In many hospitals and birthing centers, you will be required to sign a refusal form. This document is for legal and medical records, stating that you have been informed and are making a decision independent of the hospital system.
3. Post-Birth Monitoring: If you decide to refuse the ointment, it’s important to monitor your baby closely for any signs of eye infection and seek immediate medical attention if needed. Gonoccoal and chlamydia infections in newborns don’t usually show up until 2-12 days after birth (8). So, following the guidance of your pediatrician, you’ll need to be watchful throughout those first few weeks and be sure to seek care immediately if baby shows any signs of illness.

If I have a cesarean birth, will the nurse still give my baby eye ointment?

It’s logical to assume that the risk of transmitting an STI would be significantly decreased when your baby isn’t passing through the birth canal. And fortunately, this is true, especially if mom’s bag of water never broke before the cesarean (7). However, the CDC still recommends eye ointment, regardless of whether it’s a vaginal or cesarean birth (1). So, you should expect that the ointment will be administered after a cesarean as standard protocol unless you voice your choice to refuse the medication beforehand.

Conclusion

The choice to accept or refuse erythromycin eye ointment for your newborn is deeply personal and should be made with a full understanding of the risks and benefits. Always consult with your healthcare provider. By working in tandem, you can ensure that you make an informed decision that aligns with your beliefs and the best interests of your newborn.

References:

1. Centers for Disease Control and Prevention (2021). Gonococcal Infections Among Neonates. Available from: https://www.cdc.gov/std/treatment-guidelines/gonorrhea-neonates.htm
2. Curry SJ, Krist AH, Owens DK, et al. Ocular prophylaxis for gonococcal ophthalmia neonatorum: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2019;321(4):394-398.
3. Davidson, M. London, M., Ladewigh, P. (2012). Olds’ Maternal-Newborn Nursing & Women’s Health Across the Lifespan. 9th edition, pg. 831.
4. Guirguis-Blake JM, Evans CV, Rushkin M. (2019). Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: A Reaffirmation Evidence Update for the U.S. Preventive Services Task Force. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537599/
5. Kapoor VS, Whyte R, Vedula SS. Protocol: Interventions for preventing ophthalmia neonatorum. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD001862. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001862.pub3/full
6. Laga, M., Plummer, F. A., Piot, P., Datta, P., Namaara, W., Ndinya-Achola, J. O., . . . Pamba, H. O. (1988). Prophylaxis of gonococcal and chlamydial ophthalmia neonatorum. A comparison of silver nitrate and tetracycline. N Engl J Med, 318(11), 653-657. Available from: https://pubmed.ncbi.nlm.nih.gov/3278234/
7. Medves, J.M. (2002). “Three infant care interventions: reconsidering the evidence.” J Obstet Gynecol Neonatal Nurs 31(5): 563-569. Available from: https://pubmed.ncbi.nlm.nih.gov/12353736/
8. Centers for Disease Control and Prevention. Conjunctivitis (Pink Eye) in Newborns. Available from: https://www.cdc.gov/conjunctivitis/newborns.html#:~:text=A%20woman%20with%20untreated%20chlamydia,to%2012%20days%20after%20birth.