Neonatal Prophylaxis: Prevention of Vitamin K Deficiency Haemorrhage and Neonatal Ophthalmia / Neonatalna Profilaksa: Preprečevanje Krvavitev Zaradi Pomanjkanja Vitamina K in Neonatalne Oftalmije

Abstract

IntroductionThe aim of the study was to explore two aspects of neonatal prophylaxis: the application of the vitamin K injection to the newborns and the prophylaxis against chlamydial and gonococcal eye infections, comparing Slovenian and Croatian practices.MethodsA causal non-experimental method of quantitative empirical approach was used. The data was collected by means of predesigned questionnaires. The questionnaires were sent to 14 Slovenian and 32 Croatian birth hospitals. The data was analysed with descriptive statistics and the Kullback test.ResultsVitamin K is applied to all newborns in 9 (out of 14) Slovene and 22 (out of 32) Croatian birth hospitals that returned the questionnaire. The prophylaxis against chlamydial gonococcal eye infections is applied to all newborns in 9 Slovene and 16 Croatian birth hospitals that offered answers to the questionnaire. The majority of Slovene and Croatian birth hospitals perform these procedures in the first hour after birth. The majority of Slovene birth hospitals still apply vitamin K in the gluteal muscle, whereas the majority of Croatian birth hospitals usually use the thigh as an injection site. In Slovenia, 1 % Targesin is used for the prophylaxis against chlamydial and gonococcal eye infections, whereas in Croatia the prevailing medicine is Erythromycin.ConclusionsThe possibility of oral vitamin K application should be offered to parents, and pain management in practice should be discussed. The form of written informed consent could be offered to parents. Health professionals should provide intimacy and exclude routine procedures in the first couple of hours after birth. However, more research is needed as delayed administration might be related to lower efficacy and, as a consequence of that, the safety of newborns is questionable.

A Survey of Current Prophylactic Treatment for Ophthalmia Neonatorum in Croatia and a Review of International Preventive Practices

“…According to current health policy in Mexico, preventive treatment for ophthalmia neonatorum in neonates is a medico-legal requirement and consists of the application of a single drop of ophthalmic chloramphenicol in both eyes shortly after birth [ 17 ]. In Slovenia, neonatal prophylaxis is a mandatory intervention for all newborns and is performed in the first three hours after birth with the topical application of 1% silver protein acetyl tannate eye drops, which contain organically bound silver and have a similar effect to topical silver nitrate [ 4 ]. In Austria, where seven different topical treatments are used, there is a similar approach to the prevention of ophthalmia neonatorum as in Croatia, as than 90% of obstetric units in Austria routinely apply topical erythromycin, or silver nitrate, or tetracycline for newborns in maternity hospitals [ 5 ].…”

“…Conjunctivitis in newborn infants may be prevented with the use of topical prophylactic treatment of the infant or by prenatal screening and treatment of infected mothers [ 1 – 4 ]. Although there is published clinical evidence that supports the use of topical ophthalmic preventive treatment, some of these have side effects, may be costly, or may have adverse effects on the health of newborns [ 1 , 2 , 8 – 11 ].…”

“…Due to the potential complications related to ophthalmia neonatorum, many countries have now implemented routine prophylaxis or preventive treatment for ophthalmia neonatorum in newborns [ 6 , 10 , 11 ]. The agents currently used in the prevention of ophthalmia neonatorum include topical 1% silver nitrate; targesin (a silver and protein compound); 1% tetracycline; topical macrolide antibiotics, including 0.5% erythromycin or azithromycin; topical aminoglycosides, including gentamicin and tobramycin; chloramphenicol; fluoroquinolones, including ciprofloxacin; 1.25% or 2.5% povidone-iodine; and fusidic acid [ 12 , 4 , 6 , 8 , 9 , 16 – 28 ] ( Table 2 ). The use of topical antibiotic prophylaxis can be associated with the development of antimicrobial resistance [ 1 , 2 ].…”

Intersociety Position Statement on the Prevention of Ophthalmia Neonatorum in Italy

“…Taking into account WHO recommendations, each nation has issued specific guidelines based on its own profile. Countries that perform ON prophylaxis to all neonates at birth include Brazil [ 27 ], USA [ 16 , 28 ], Spain [ 29 ], Slovenia [ 30 ], Turkey [ 31 ], Ghana [ 7 ] and Chile [ 32 ]; prophylaxis is also undertaken in certain areas of Central America, some countries in Africa, parts of the Far East, areas of the Middle East and parts of Central Asia [ 6 ]. Conversely, other countries with well-organized systems of prenatal care, such as Denmark, the Netherlands, Norway, Sweden, France, Belgium, the UK, Canada and Australia, recommended the discontinuation of ocular prophylaxis several years ago [ 4 , 13 , 15 ].…”