Interventions for preventing ophthalmia neonatorum

Area of Science:

• Ophthalmology
• Neonatal Care
• Infectious Diseases

Background:

• Ophthalmia neonatorum is a serious eye infection in newborns that can lead to blindness, especially when caused by Neisseria gonorrhoeae.
• Prophylactic antiseptic or antibiotic eye medications are administered to newborns shortly after birth to prevent neonatal conjunctivitis and potential vision impairment.

Purpose of the Study:

• To evaluate the effectiveness of systemic or topical eye medications compared to placebo or no prophylaxis in preventing ophthalmia neonatorum.
• To compare the efficacy of different systemic or topical eye medications against each other for ophthalmia neonatorum prevention.

Main Methods:

• A systematic review and meta-analysis of randomized and quasi-randomized controlled trials were conducted.
• Searches included CENTRAL, MEDLINE, Embase, LILACS, and trials registers up to October 2019, supplemented by reference checking and industry contact.
• Included studies compared various prophylactic regimens against placebo, no prophylaxis, or each other, assessing outcomes like blindness, conjunctivitis, and adverse effects.

Main Results:

• Thirty trials involving 79,198 neonates were included, with most studies at high risk of bias.
• No studies reported data on preventing blindness or adverse visual outcomes.
• Moderate-certainty evidence indicated a probable reduction in any cause conjunctivitis (ACAE), but evidence for gonococcal (GC), chlamydial (CC), or bacterial conjunctivitis (BC) was less certain. Adverse effects like nasolacrimal duct obstruction and keratitis did not show increased risks.

Conclusions:

• Current evidence does not confirm if ophthalmia neonatorum prophylaxis prevents blindness or adverse visual outcomes.
• Prophylaxis likely reduces the incidence of any cause conjunctivitis in newborns, though evidence for specific pathogens is limited.
• Further research, potentially comparing tetracycline, povidone-iodine, and chloramphenicol, is needed to identify a universally effective prophylaxis.