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

Appeared in: NORCET 9 Prelims-2025

Explanation

Erythromycin 0.5% ophthalmic ointment is the universally recommended prophylactic agent for all newborns to prevent ophthalmia neonatorum.
The primary purpose of this prophylaxis is to prevent gonococcal conjunctivitis, a severe condition that can cause blindness.
Although its efficacy against Chlamydia is limited, it is still the standard of care administered to all newborns, including those born to mothers with Chlamydia.
The infant's asymptomatic status calls for routine prevention, not treatment for an active infection.

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: Systemic tetracycline is contraindicated in neonates because it can cause permanent staining of developing teeth and affect bone growth. Topical tetracycline is an older prophylactic agent and is no longer the standard of care.
Option D: Silver nitrate is an outdated prophylactic agent that is largely ineffective against Chlamydia and has a high rate of causing chemical conjunctivitis, which can irritate the eyes and complicate assessment.

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.
Administering prophylactic eye ointment is a mandatory nursing intervention for all newborns in most healthcare settings to prevent the devastating complication of blindness from gonococcal ophthalmia.
Patient education is critical. The nurse must inform parents of a Chlamydia-positive mother to monitor the infant for delayed-onset signs of conjunctivitis (eye discharge, redness, swelling) or pneumonia (cough, rapid breathing), as these can appear 5-14 days after birth.
What if the infant develops copious purulent eye discharge and eyelid swelling at 10 days of life? The nurse should anticipate that this is likely chlamydial conjunctivitis. The appropriate action is to notify the healthcare provider, prepare to collect specimens for testing, and anticipate a prescription for systemic (oral) erythromycin for treatment.

How to Approach the Question

First, identify the core of the question: it asks for a preventive measure (prophylaxis) in an asymptomatic newborn.
Recognize the context: the mother has Chlamydia, which is a risk factor for ophthalmia neonatorum.
Recall the standard, universal nursing care provided to all newborns immediately after birth. Eye prophylaxis is a key component of this care.
Differentiate between prophylaxis (given to all to prevent disease) and treatment (given to those with active disease). Since the baby is asymptomatic, the answer must be a prophylactic agent.
Evaluate the options based on current standards for newborn eye prophylaxis. Erythromycin 0.5% ointment is the current standard in most regions.
Eliminate the incorrect options: Oral erythromycin is for treatment. Tetracycline is contraindicated. Silver nitrate is an outdated method with significant side effects.

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: Mother is positive for Chlamydia trachomatis
Clinical cues: Newborn is asymptomatic

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E6 Obstetrics Williams p. 2-9

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 1747-1749

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 1 (pp 36-238 of 713) p. 198-200

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Attempt every question from this paper in a timed mock, then review the full solution for each one.