Ocular Prophylaxis for Gonococcal Neonatorum-Infant

Summary of Recommendation and Evidence

Population	Recommendation	Grade (What's This?)
All Newborns	The USPSTF recommends prophylactic ocular topical medication for all newborns for the prevention of gonococcal ophthalmia neonatorum.	A

Importance

Gonococcal ophthalmia neonatorum develops in approximately 28% of infants born to women with gonorrheal disease in the United States. Identifying and treating the infection is important because gonococcal ophthalmia neonatorum can result in corneal scarring, ocular perforation, and blindness.

Recognition of Risk Status

The USPSTF recommends that all newborns receive prophylaxis; however, some newborns are at increased risk for gonococcal ophthalmia neonatorum. Newborns at increased risk include those with a maternal history of sexually transmitted infections, substance abuse, or no prenatal care.

Benefits of Risk Assessment and Preventive Medication

There is convincing evidence that blindness due to gonococcal ophthalmia neonatorum has become rare in the United States since the implementation of universal prophylaxis of newborns.

Harms of Risk Assessment and Preventive Medication

There is convincing evidence that universal prophylaxis of newborns is not associated with serious harms.

USPSTF Assessment

The USPSTF concludes that there is high certainty that the net benefit is substantial for topical ocular prophylaxis for all newborns for the prevention of gonococcal ophthalmia neonatorum.

Patient Population Under Consideration

This recommendation applies to all newborns.

Preventive Medication

Prophylactic regimens using 1.0% tetracycline or 0.5% erythromycin ophthalmic ointment are considered equally effective in the prevention of gonococcal ophthalmia neonatorum; however, the only drug approved by the U.S. Food and Drug Administration for this indication is 0.5% erythromycin ophthalmic ointment. Tetracycline ophthalmic ointment and silver nitrate are no longer available in the United States. A 2.5% solution of povidone-iodine may be useful in preventing ophthalmia neonatorum, but it has not been approved for use in the United States at this time.

Optimal Timing

Prophylaxis should be provided within 24 hours after birth.