BACKGROUND AND PURPOSE:

• Kapoor et al. (Cochrane Systematic Reviews, 2020) sought to determine if pharmacologic prophylaxis is superior to placebo for the prevention of ophthalmia neonatorum, and if so, which is the preferred medication

METHODS:

• Systematic review and meta-analysis
  • Aside from usual database searches and reference checks, the authors also contacted pharmaceutical companies
• Inclusion criteria
  • Randomized and quasi-randomized controlled trials
  • Studies that examined any topical, systemic, or combination medical interventions used to prevent ophthalmia neonatorum in newborns compared with placebo, no prophylaxis, or with each other
• Study design
  • Study was conducted with standard Cochrane methods
• Primary outcomes
  • Blindness or any adverse visual outcome at 12 months
  • Conjunctivitis at 1 month: Gonococcal (GC) | Chlamydial (CC) | Bacterial (BC) | Any etiology (ACAE) | Unknown etiology
  • Adverse effects

RESULTS:

• 30 trials | 79,198 total neonates
  • High-income settings: 18 trials | Low- and middle-income settings: 12 trials
  • Total of 14 different prophylactic regimens and 12 different medications

Any Prophylaxis Compared to No Prophylaxis

• Studies assessed one or more of the following
  • Tetracycline 1% | Erythromycin 0.5% | Povidone-iodine 2.5% | Silver nitrate 1%
• None of the studies reported data on blindness or any adverse visual outcome
• Low-certainty evidence regarding risk of GC with prophylaxis vs no prophylaxis at one month
  • Risk ratio (RR) 0.79 (95% CI, 0.24 to 2.65)
• Low-certainty evidence suggested there may be little or no difference in effect on risk of
  • CC: RR 0.96 (95% CI, 0.57 to 1.61)
  • BC: RR 0.84 (95% CI, 0.37 to 1.93)
• Moderate-certainty evidence suggested a probable reduction in risk of ACAE at one month
  • RR 0.65 (95% CI, 0.54 to 0.78)
• There was very-low certainty evidence on the risk of CUE
  • RR 1.75 (95% CI, 0.37 to 8.28)
• There was very low-certainty evidence of adverse effects, but the evidence suggested no increased risk for the following
  • Nasolacrimal duct obstruction: RR 0.93 (95% CI, 0.68 to 1.28)
  • Keratitis: Single study of 40 newborns assessing silver nitrate 1% with no events

Any Prophylaxis Compared to Another Prophylaxis

• There was no consistently superior intervention
• Most evidence was of low-certainty and very limited

CONCLUSION:

• Serious outcomes
  • There is no data on whether taking prophylactic measures for ophthalmia neonatorum prevents blindness or adverse visual outcomes
• Preventing conjunctivitis
  • The use of prophylaxis may lead to a reduction in the incidence of conjunctivitis of any etiology
  • The evidence on gonococcal, chlamydial, and bacterial conjunctivitis was less certain
• The authors suggest a future trial to determine which medication works best

Learn More – Primary Sources:

Interventions for preventing ophthalmia neonatorum

Related ObG Topics:

STI Screening in Pregnancy: CDC Recommendations

Chlamydia: CDC Recommendations for Diagnosis and Treatment