Routine Eye Ointment for the Newborn: Erthyromycin Eye Ointment
The routine administration of eye ointment to newborns is given to prevent eye infection and
possible blindness from occurring.
Midwives administer antibiotic eye ointment to all newborns within the first few hours of life.
Midwives are required to do this by law in Ontario. Erythromycin eye ointment is used. A small
amount of this nonirritating antibiotic is administered to the newborn’s eyes. Midwives administer
this ointment when the baby has had time to bond with the family and is often ready for a nap.
The medication is absorbed into the newborns eyes within a short period of time.
The College of Midwives of Ontario States:
"Informed choice is a fundamental part of midwifery care in Ontario and is recognized as such in
the standards of the College of Midwives. However, the Health Care Consent Act, 1996, does not
allow for exemptions based on informed choice in the application of eye prophylaxis for newborns.
In other words, the midwife is required by law to administer eye prophylaxis and she is not
required to receive consent in order to do so. This is the current state of law. While the law does
not allow for choice in this situation, the College still expects midwives to discuss prophylaxis with
clients prior to its administration.“
A midwife who fails to administer eye ointment is breaking the law. The implications can include
the midwife losing her license to practice, assuming all financial and legal liabilities for this action,
and being unable to provide midwifery care to other woman.
Vitamin K: Prevention of Hemorrhagic Disease of the Newborn (HDNB)
What is Hemorrhagic Disease of the Newborn?
It is a bleeding disorder that can occur most commonly within the first few days of a newborns life,
but can occur at any time after birth. It often presents as unexpected bleeding in the
gastrointestinal tract, in the tissue through ruptured blood vessels, and in many instances through
bleeding within the skull and brain. It is very serious and treatment is often difficult as signs and
symptoms show up after the baby has already suffered severe damage.
What Causes Hemorrhagic Disease of the Newborn?
Vitamin K deficiency is the main cause. Vitamin K is important in the production of some clotting
factors in our blood. Babies are born with very little vitamin K. Vitamin K is made by the bacterial
flora in the gastrointestinal system. Babies are born with a sterile gut and need to be digesting
food in order to produce this flora needed to make vitamin K.
Who is Affected by Hemorrhagic Disease of the Newborn?
HDNB is rare. It affects less than 2% of babies, but some are at greater risk than others. Babies
born prematurely, babies born to mothers who take medications for seizure disorders, babies that
are breastfed (breast milk contains less vitamin K than formula), difficulty deliveries (like vacuum
or forceps), significant moulding or bruising of the head and babies who do not receive
preventative vitamin K injection at the birth.
Why is Hemorrhagic Disease of the Newborn a Concern?
Without the clotting factor, bleeding may occur that can be severe and a hemorrhage can
develop. Because common sites for bleeding to occur are in the tissues, the brain, and the
stomach, symptoms may not be apparent immediately.
What are the Symptoms of Hemorrhagic Disease of the Newborn?
Symptoms of bleeding can be different for every infant but may include; blood in the bowel
movement or urine, oozing of blood around the umbilical cord or bruising. There may be bleeding
internally that cannot be seen causing damage to organs inside the body. This bleeding can
happen anytime in the first few weeks of life. However, it most commonly occurs in the first few
days and can lead to severe damage such as brain damage, or even death.
How is Hemorrhagic Disease of the Newborn Prevented?
The majority of HDNB cases are caused by vitamin K deficiency. The one way we know of
preventing HDNB is by administering a synthetic form of Vitamin K. It is recommended by the
Canadian Pediatric Society that all newborns receive 1 mg of vitamin K after birth by injection
using a tiny needle administered into the thigh of the infant. There are no side effects of the
vitamin K injection other than a small bit of discomfort from the needle at the time of injection.
Administration of vitamin K after birth prevents almost all cases of HDNB. The risk of HDNB with a
single injection drops to 1/1,439,120!!! It has been proven that oral the form of vitamin K is not as
effective at preventing HDNB.