Ocular Prophylaxis for Neonatal Infections

Ocular prophylaxis for neonatal infections, traditionally aimed at preventing ophthalmia neonatorum, has evolved from the 19th-century use of silver nitrate to modern antibiotic and antiseptic regimens. Newborn conjunctivitis, chiefly caused by Neisseria gonorrhoeae and Chlamydia trachomatis acquired during passage through the birth canal, can lead to corneal scarring and vision loss if untreated. Universal prophylaxis with topical agents within hours of birth has been adopted in many regions, yet practices vary widely according to local legislation, resource availability and maternal screening strategies. Current preparations include erythromycin and tetracycline ointments, povidone-iodine drops and emerging non-antibiotic compounds. Efforts to balance efficacy, safety and parental acceptance have driven research towards agents that are rapidly bactericidal, non-irritating and stable under field conditions. Concurrently, enhanced prenatal screening and treatment of maternal infections have emerged as complementary measures to reduce neonatal risk. Recent advances focus on novel formulations that address antimicrobial resistance, improve ocular tolerance and extend shelf-life, thereby ensuring practical implementation in diverse healthcare settings.

Research from Nature Portfolio

Recent studies have demonstrated the potential of monoglycerides as a new class of ocular prophylactic agents. In particular, a thickened eye-drop formulation containing 0.25 % monocaprin in a hydroxypropyl methylcellulose base with polysorbate 20 rapidly eradicates N. gonorrhoeae and other pathogens in ex vivo infection models. This formulation retained full antimicrobial activity after three years of storage and was non-irritating in ocular assays, outperforming povidone-iodine preparations. The work highlights the feasibility of stable, non-antibiotic prophylaxis that may circumvent the growing challenge of antibiotic resistance and provides a clear pathway for formulation optimisation and clinical evaluation.

Ocular Prophylaxis for Neonatal Infections publication trend

The graph below shows the total number of articles in ocular prophylaxis for neonatal infections across all publications each year (not limited to Nature Index journals).

Technical terms

Ophthalmia neonatorum: Acute conjunctivitis in neonates within the first 28 days of life, often caused by N. gonorrhoeae or C. trachomatis.

Prophylaxis: Preventative treatment administered to avert onset of infection; in this context, topical ocular application at birth.

Neisseria gonorrhoeae: Gram-negative bacterial pathogen that can infect the neonatal conjunctiva, leading to rapid corneal damage.

Chlamydia trachomatis: Intracellular bacterial pathogen causing neonatal conjunctivitis and respiratory infection, less responsive to topical antibiotics.

Monocaprin: A monoglyceride with broad-spectrum bactericidal activity under investigation as a non-antibiotic ocular prophylactic.

References

1. Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns. BMC Infectious Diseases (2021).
2. Monocaprin eye drop formulation to combat antibiotic resistant gonococcal blindness. Scientific Reports (2020).
3. Antibiotic prophylaxis for ophthalmia neonatorum in Italy: results from a national survey and the Italian intersociety new position statements. Italian Journal of Pediatrics (2023).