Knowledge and practice of nursing professionals about prophylaxis of ophthalmia neonatorum / Conocimiento y la práctica de profesionales de enfermería sobre profilaxis de la oftalmía neonatal / Conhecimento e prática de profissionais de enfermagem sobre profilaxia da oftalmia neonatal

Abstract Objective: To analyze the knowledge and practice of nursing professionals about the prophylaxis of ophthalmia neonatorum. Method: Descriptive study, of qualitative approach, carried out in the first semester of 2018, in a city hall hospital located in the lake area of the Rio de Janeiro's state, through semi-structured interviews with 14 Nursing professionals participating in the care of the newborn, whose data were submitted to the Thematic Analysis. Results: From the three emerging thematic categories, there are gaps in knowledge related to ophthalmia neonatorum, silver nitrate and the instillation procedure of this prophylactic solution, as well as differences in care practice regarding care before, during and after the procedure. Conclusion and implications for practice: The data point to the importance of training the Nursing team in the prophylaxis of ophthalmia neonatorum, the revision of guidelines and procedures aimed at standardizing the procedure, as well as emphasizing the need for adequate follow-up of pregnant women in prenatal care.

Resumen Objetivo: Analizar el conocimiento y la práctica de los profesionales de Enfermería sobre la profilaxis de la oftalmía neonatal. Método: Estudio descriptivo, de naturaleza cualitativa, realizado en el primer semestre de 2018, en un hospital municipal ubicado en la bajada costera del estado de Río de Janeiro, a través de entrevistas semiestructuradas desarrolladas con 14 profesionales de Enfermería, que participan en la asistencia al recién nacido, cuyos datos se sometieron al análisis temático. Resultados: A partir de las tres categorías temáticas emergentes se evidencian lagunas en el conocimiento relacionadas a la oftalmía neonatal, al nitrato de plata y al procedimiento de instilación de esa solución profiláctica, además de divergencias en la práctica asistencial en cuanto a los cuidados antes, durante y después de la realización del procedimiento. Conclusión y las implicaciones para la práctica: Los datos apuntan a la importancia de la capacitación del equipo de Enfermería para la realización de la profilaxis de la oftalmia neonatal, de la revisión de directrices y conductas que visen la estandarización del procedimiento, además de resaltar la necesidad de un acompañamiento adecuado de las gestantes en el prenatal.

Resumo Objetivo: Analisar o conhecimento e a prática de profissionais de Enfermagem sobre profilaxia da oftalmia neonatal. Método: Estudo descritivo, de natureza qualitativa, realizado no primeiro semestre de 2018, em um hospital municipal localizado na baixada litorânea do estado do Rio de Janeiro, por meio de entrevistas semiestruturadas com 14 profissionais de Enfermagem, que participam da assistência ao recém-nascido, cujos dados foram submetidos à Análise Temática. Resultados: A partir das três categorias temáticas emergentes evidenciaram-se lacunas no conhecimento relacionadas à oftalmia neonatal, ao nitrato de prata e ao procedimento de instilação dessa solução profilática, além de divergências na prática assistencial quanto aos cuidados antes, durante e após a realização do procedimento. Conclusão e implicações para a prática: Os dados apontam para a importância da capacitação da equipe de Enfermagem para a realização da profilaxia da oftalmia neonatal, da revisão de diretrizes e condutas que visem a padronização do procedimento, além de ressaltar a necessidade de um acompanhamento adequado das gestantes no pré-natal.

Conjuntivite neonatal com ênfase na sua prevenção / Neonatal conjunctivitis with emphasis on its prevention

Nos últimos tempos, a necessidade da utilização de medicamentos para prevenção da conjuntivite neonatal (CN) passou a ser questionada em alguns países desenvolvidos, devido ao elevado nível de assistência pré-natal. Ao contrário, no Brasil, embora não haja dados oficiais sobre sua ocorrência, vários trabalhos recentes comprovam elevada prevalência da infecção genital em mulheres em idade fértil e em gestantes. Isso, aliado ao fato de que o índice de transmissão da infecção genital por clamídia e gonococo, da mãe infectada para o recém-nascido é de 30 a 50 por cento, leva à conclusão de que a profilaxia medicamentosa está mais que justificada. A CN implica em importante potencial de complicações locais e sistêmicas, além da necessidade de exames laboratoriais para seu diagnóstico etiológico. Por isso, constitui importante problema de saúde pública, negligenciado no Brasil, onde não há padronização do método de prevenção. Embora o uso do nitrato de prata pareça ainda ser o método oficial, seu uso tem sido questionado devido à incompleta proteção contra clamídia, principal agente da conjuntivite neonatal nos dias atuais, e pela frequente ocorrência de conjuntivite química. Por isso, tem sido substituído por outros agentes, como a eritromicina, a tetraciclina, além de outros antibióticos. A superioridade da Iodopovidona em relação a esses antibióticos, nos vários quesitos analisados, tem sugerido que esse é o mais adequado entre os produtos, testados até o momento, para prevenção da CN.

Nowadays the use of drugs for prevention of neonatal conjunctivitis (NC) has been questioned in some developed countries, due to the high level of prenatal care. In Brazil, although no official data on the occurrence of NC is available, several recent studies has shown high prevalence of genital infection in childbearing age and pregnant women. This, coupled with the 30 percent to 50 percent transmission rate of genital chlamydia and gonococcus from mother to newborn, leads to the conclusion that chemoprophylaxis is justified. The potential for local and systemic complications and the need for laboratory tests for its diagnosis have made NC an important public health problem, overlooked in Brazil, where there is no standardization of the method of prevention. Although the use of silver nitrate still appears to be the official method, it has been questioned due to incomplete protection against chlamydia, nowadays the leading agent of NC, and by the frequent occurrence of chemical conjunctivitis. So, it has been replaced by other agents such as erythromycin, tetracycline and other antibiotics. The advantages of povidone-iodine compared to these agents in the various items analyzed, has suggested that it is the best, among the products tested so far, for the prevention of NC.

Chlamydia trachomatis causing neonatal conjunctivitis in a tertiary care center.

Chlamydia trachomatis is considered a major aetiological agent of conjunctivitis in newborns. The objective of the present study was to determine the aetiology of neonatal conjunctivitis and clinico-epidemiological correlates of chlamydial ophthalmia neonatorum. Fifty-eight newborns with signs and symptoms of conjunctivitis were studied. Conjunctival specimens were subjected to Gram staining, routine bacteriological culture, culture for Neisseria gonorrhoeae and direct fluorescent antibody (DFA) staining for diagnosis of C. trachomatis infection. C. trachomatis was detected in 18 (31%) neonates. Findings suggest that since C. trachomatis is the most common cause of neonatal conjunctivitis, routine screening and treatment of genital C. trachomatis infection in pregnant women and early diagnosis and treatment of neonatal Chlamydial conjunctivitis may be considered for its prevention and control.

Avaliação da aplicabilidade e do custo da profilaxia da oftalmia neonatal em maternidades da grande Florianópolis / Evaluating of the applicability and cost of the prophylaxis of the ophthalmia neonatorum in maternities of greater Florianopolis

OBJETIVOS: Avaliar a aplicabilidade da profilaxia da oftalmia neonatal em cinco serviços de obstetrícia de maternidades da Grande Florianópolis no período de março de 2007. MÉTODOS: Cinco serviços de obstetrícia de maternidades da Grande Florianópolis foram visitados e questionados quanto ao método realizado na prevenção da ON, o custo por unidade de colírio utilizado, o conhecimento do método de Credé e a legislação vigente. RESULTADOS: As soluções profiláticas utilizadas foram a iodopovidona a 2,5 por cento e o vitelinato de prata a 10 por cento. O uso do vitelinato de prata a 10 por cento foi predominante entre os serviços analisados (60 por cento) e também o de menor custo (de R$ 5,26 a R$ 7,23 por frasco de 5ml), quando comparado a iodopovidona a 2,5 por cento que apresentou custo de R$ 15,00 por frasco de 5 ml e R$ 25,40 por frasco de 10 ml. Entre os entrevistados, apenas um tinha conhecimento sobre a legislação vigente acerca da aplicabilidade da profilaxia da oftalmia neonatal. CONCLUSÃO: A aplicabilidade da profilaxia neonatal na maioria dos serviços de obstetrícia das maternidades da Grande Florianópolis é realizada de maneira incorreta e não está em concordância com a legislação vigente.

OBJECTIVE: To evaluate the applicability of the ophthalmia neonatorum prophylaxis in five maternities obstetric services of Greater Florianopolis, Brazil; during march 2007. METHODS: Five maternities obstetric services of Greater Florianopolis were visited and questioned about the method carried through in the prevention of the ON, the cost for unit of used eye drops unit, the knowledge of the Credé method and the current legislation. RESULTS: The prophylactic solutions used were povidone-iodine 2.5 percent and silver vitelinate 10 percent. The use of silver vitelinate 10 percent was predominant in the analyzed services (60 percent) and also of lower cost (from R$ 5,26 to R$ 7,23 for bottle of 5 ml) when compared with povidone-iodine 2.5 percent that had cost of R$ 15,00 the 5 ml bottle and R$ 25,40 the 10 ml bottle. Among interviewees only one had knowledge on the current legislation concerning the applicability of the prophylaxis of the ophthalmia neonatorum. CONCLUSIONS: The applicability of the neonatal prophylaxis in the majority of the maternities obstetric services of Greater Florianopolis is carried through incorrect way and it is not in agreement with the current legislation.

Neonatal conjunctivitis - A review

Ophthalmia neonatorum remains a significant cause of ocular morbidity, blindness and even death in underdeveloped countries. The organisms causing ophthalmia neonatorum are acquired mainly from the mother’s birth canal during delivery and a small percentage of cases are acquired by other ways. Chlamydia and Neisseria are the most common pathogens responsible for the perinatal infection. Fortunately in most cases, laboratory studies can identify the causative organism and unlike other form of conjunctivitis, this perinatal ocular infection has to be treated with systemic antibiotics to prevent systemic colonization of the organism. Routine prophylaxis with 1% silver nitrate solution (crédés method) has been discontinued in many developed nations for the fear of development of chemical conjunctivitis

The comparision of in vitro antibacterial activities of two drugs for ophthalmia neonatorum prophylaxis / 中国药学杂志

OBJECTIVE:To eualuate in vitro antibacterial activities of silver nitrate and povidone-iodine for preventing ophthalmia neonatorum. METHODS:Minimal inhibitory concentration(MIC) and mininmal bactericidal concentration (MBC) were deter-mined by double broth dilution method. RESULTS:For Stapanrens Streppnenmonia and N gonorhveae,the MIC50 of silver nitrate were＜4～8μg.ml－1 and its MIC90 were 8～32μg.ml－1.The MIC50 of povidone-iodine were64～256μg.ml－1 and its MBC90were 512 μg.ml-1. CONCLUSION: Silver nitrate and povidone-iodine exhibited activities against common pathogens of ophthalmia neonatorum isolates.Silver nitrate was more active than povidone-iodine.

Effect of 1% Povidone-iodine for Ophthalmia Neonatorum Prophylaxis

It has been reported that 2.5% povidone-iodine solution was an effective antimicrobial agent on the conjunctivae of newborns and caused less toxicity than silver nitrate eye drops. The effectiveness and the safety of 1% povidoneiodine solution, a lower concentration solution, were evaluated on ophthalmia neonatorum prophylaxis. A bacterial culture was taken from each conjunctiva of 70 neonates within 30 minutes after birth. A drop of each of the two agents, which were randomly chosen among 1% povidone-iodine solution, 2.5% povidone-iodine solution. and 1% silver nitrate eye drops, was placed on each conjunctiva. Conjunctival bacterial cultures were again taken two to four hours after birth. Before the first culture and at 24 hours after birth, the eyes were examined for toxic changes. To evaluate the effectiveness of the medications, the numbers of bacterial species and colonyforming units from each culture were compared. All three agents significantly reduced the numbers of species and colonyforming units(p0.7) but silver nitrate eye drop did(p<0.02). Therefore, it was found that 1% povidone-iodine solution as well as 2.5% povidone-iodine solution are effective antibacterial agents on the conjunctivae of newborns and cause less toxicity than silver nitrate eye drops.