PEDIATRICS Vol. 92 No. 6 December 1993, pp. 755-760
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bell, T. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bell, T. A.

Randomized Trial of Silver Nitrate, Erythromycin, and No Eye Prophylaxis for the Prevention of Conjunctivitis Among Newborns Not at Risk for Gonococcal Ophthalmitis

Thomas A. Bell MD, MPH1, J. Thomas Grayston MD2, Marijane A. Krohn PhD3, Richard A. Kronmal PhD4, and The Eye Prophylaxis Study Group

1 From the Departments of Epidemiology, Pediatrics, University of Washington, Seattle
2 From the Departments of Epidemiology, Pathobiology, University of Washington, Seattle
3 From the Departments of Epidemiology, Obstetrics and Gynecology, University of Washington, Seattle
4 From the Department of Biostatistics, University of Washington, Seattle

Objective. To compare the efficacy of commonly used forms of eye prophylaxis for newborns with no prophylaxis in the prevention of nongonococcal conjunctivitis.

Design. Randomized doubly masked clinical trial.

Setting. University of Washington Hospital and affiliated clinics, Seattle, between 1985 and 1990.

Subjects. The medical records of 8499 women were evaluated for possible participation; 2577 were eligible. Of the 758 enrolled, the infants of 630 were evaluable.

Intervention. Comparison of silver nitrate, erythromycin, and no eye prophylaxis given at birth for the prevention of conjunctivitis.

Main outcome measures. Conjunctivitis during the first 60 days of life and nasolacrimal duct patency in the first 2 days of life.

Results. The frequency of impatent tear ducts at the 30- to 48-hour examination did not differ significantly by prophylaxis group. Among the 630 infants randomized and observed, 109 (17%) developed mild conjunctivitis. Sixty-nine (63%) of the cases appeared during the first 2 weeks of life. After 2 months of observation, infants allocated to silver nitrate eye prophylaxis at birth had a 39% lower rate of conjunctivitis (hazard ratio = 0.61, 95% confidence interval = 0.39 to 0.97), and those allocated to erythromycin had a 31% lower rate of conjunctivitis (hazaid ratio = 0.69, 95% confidence interval = 0.44 to 1.07), than did those allocated to no prophylaxis.

Conclusion. Silver nitrate eye prophylaxis caused no sustained deleterious effects and even provided some benefit to infants born to women without Neisseria gonorrhoeae. However, the effect was modest and against microorganisms of low virulence. The results suggest that parental choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy.

Key Words: eye prophylaxis • infants • conjunctivitis • ophthalmia neonatorum • silver nitrate • erythromycin

Submitted on November 23, 1992
Accepted on May 25, 1993




This article has been cited by other articles:


Home page
 NEJMHome page
S. J. Isenberg, L. Apt, and M. Wood
A Controlled Trial of Povidone-Iodine as Prophylaxis against Ophthalmia Neonatorum
N. Engl. J. Med., March 2, 1995; 332(9): 562 - 566.
[Abstract] [Full Text] [PDF]

Home page
 JWatch GeneralHome page
EYE PROPHYLAXIS MAY AVERT NEONATAL NONGONOCOCCAL CONJUNCTIVITIS
Journal Watch (General), January 14, 1994; 1994(114): 6 - 6.
[Full Text]