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Gonococcal ophthalmia neonatorum. Relationship of maternal factors and delivery room practices to effective control
Insights
Neonatal ophthalmia caused by gonococci occurred in 13 infants despite silver nitrate eye prophylaxis. This highlights the need for improved maternal screening and diagnostic methods for gonorrhea to prevent infant infections.
Area of Science:
- Ophthalmology
- Neonatal Care
- Infectious Diseases
Background:
- Neonatal ophthalmia, specifically gonococcal ophthalmia, remains a significant concern in newborn care.
- Despite routine prophylaxis, cases of gonococcal ophthalmia continue to be reported.
Purpose of the Study:
- To report the incidence of gonococcal ophthalmia in infants born at a specific medical center.
- To identify risk factors associated with neonatal gonococcal ophthalmia.
- To evaluate the effectiveness of current preventive measures.
Main Methods:
- Retrospective review of infant cases with confirmed or presumptive gonococcal ophthalmia.
- Analysis of maternal histories, including prenatal care, history of gonorrhea, and serological tests.
- Review of prophylaxis administration (silver nitrate).
Main Results:
- 11 infants had culture-proven gonococcal ophthalmia, and 2 had presumptive evidence.
- Maternal risk factors included lack of prenatal care (10), history of gonorrhea (3), and positive serology (2).
- The overall incidence of gonorrhea in the prenatal clinic was very low (0.02%).
Conclusions:
- Current prevention strategies, including silver nitrate instillation, may not be fully effective against gonococcal ophthalmia.
- Vigorous screening of mothers for gonorrhea during prenatal visits and at delivery is crucial.
- Development of improved serologic and bacteriologic diagnostic methods for gonorrhea is needed.
Abstract:
Gonococcal opthalmia (proved by cultures) occurred in 11 infants delivered at the Jewish Hospital and Medical Center of Brookly (JHMCB) during a three and one-half-year period. Two more infant had conjunctivitis with presumptive evidence of gonococci (Gram stain of eye discharge). Silver nitrate was instilled in the eyes of the neonates by registered nurses. Maternal histories of these infants showed lack of prenatal care in ten, history of gonorrhea in pregnancy in three, and positive serology (STS) in two; ten of the mothers were unmarried. The over-all incidence of gonorrhea at the JHMCB prenatal clinic screening program is very low (0.02 per cent). Prevention of neonatal gonorrheal ophthalmia depends on: vigorous screening of mothers at delivery as well as during prenatal visits, careful attention to instillation of silver nitrate in the neonates' eyes, development of serologic tests for gonorrhea, and improved bacteriologic methods for culturing the organism.