A mother is positive for Chlamydia trachomatis at delivery. Her newborn is asymptomatic. What should be given to the baby to prevent ophthalmia neonatorum?

1. A

   Erythromycin 0.5% ophthalmic ointment

2. B

   Erythromycin oral

3. C

   Tetracycline

4. D

   1% AgNO₃ (Silver Nitrate)

Appeared in: NORCET 9 Prelims-2025

Explanation

Listen in Hindi

• Erythromycin 0.5% ophthalmic ointment is the universally recommended prophylaxis for all newborns to prevent ophthalmia neonatorum, primarily targeting Neisseria gonorrhoeae.
• Although its efficacy against Chlamydia trachomatis is limited, it remains the standard of care for all neonates, including those born to mothers with chlamydia.
• The infant is given the standard topical prophylaxis and then monitored for the development of chlamydial conjunctivitis or pneumonia, which would then be treated with systemic antibiotics.
• This approach avoids the risks associated with prophylactic systemic antibiotics in an asymptomatic newborn.

Why Other Options Were Wrong

• Option B: Oral erythromycin is a systemic antibiotic used for the treatment of active chlamydial conjunctivitis or pneumonia, not for prophylaxis in an asymptomatic newborn.
• Option C: Tetracycline ointment is no longer recommended or available for neonatal eye prophylaxis. Systemic tetracycline is contraindicated in neonates due to adverse effects on developing teeth and bones.
• Option D: Silver nitrate is an outdated prophylactic agent that is ineffective against Chlamydia and is known to cause severe chemical conjunctivitis.

Related Visual

• Visual 1: Infographic - A flowchart showing the management of a newborn born to a mother with Chlamydia. It would start with the birth of an asymptomatic infant, lead to the administration of erythromycin ointment, and then branch to 'monitor for symptoms.' If symptoms develop, it would lead to 'start oral erythromycin.'
• Visual 2: Image - A close-up photograph demonstrating the correct technique for applying ophthalmic ointment to a newborn's eye, from the inner to the outer canthus in the lower conjunctival sac.

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Prophylaxis for Ophthalmia Neonatorum in Newborns as background academic context rather than a clinical decision trigger.
• Universal eye prophylaxis is a critical public health measure to prevent neonatal blindness, primarily from gonococcal infection.
• Nurses must distinguish between prophylaxis for all newborns and targeted treatment for symptomatic infants. Administering systemic antibiotics prophylactically is not the standard and carries risks.
• Patient education is vital. The nurse must teach the parents of an at-risk infant to recognize and report signs of chlamydial conjunctivitis (eye discharge, swelling) or pneumonia (cough, rapid breathing) that may appear weeks after birth.

How to Approach the Question

• First, identify the key elements in the question: the patient is a 'newborn,' the condition is 'asymptomatic,' the maternal history is 'Chlamydia trachomatis positive,' and the goal is 'prevention' (prophylaxis).
• Recognize that 'prevention' in an 'asymptomatic' patient points to a standard prophylactic measure, not an active treatment.
• Recall the universal standard of care for neonatal eye prophylaxis. All newborns in the US receive an antibiotic eye ointment shortly after birth.
• Evaluate the options based on this standard. Erythromycin 0.5% ophthalmic ointment is the current standard agent.
• Differentiate this from the treatment for an active infection. Oral erythromycin is for treatment, not prophylaxis.
• Eliminate outdated or harmful options like tetracycline and silver nitrate.

Concept Tested & Keywords

• Concept Tested: Prophylaxis for Ophthalmia Neonatorum in Newborns
• Stem keywords: Chlamydia trachomatis, newborn, asymptomatic, prevent ophthalmia neonatorum
• Lead-in keywords: What should be given
• Clinical cues: The newborn is asymptomatic, which points toward prophylaxis rather than treatment.
• Clinical cues: The mother is positive for Chlamydia, indicating the newborn is at risk.

Question ID

QaMK8jzeHlN2QC8FOR43IN

Copy ID