Ophthalmia Neonatorum

Kai Tiaki : the journal of the nurses of New Zealand, Volume XIII, Issue 4, 1 October 1920, Page 181

Ophthalmia Neonatorum

Thomas Stevenson

A Lecture to the Liverpool and District Trained Midwives Association

By

M.D., Hon. Surgeon, St. Paul's Eye Hospital, Liverpool.

It falls to the lot of midwives to be the first persons to have the care of the newlyborn infant, and we naturally look to them to -see that everything possible is done to prevent any form of preventable disease from attacking the child. I know that m your course of lectures you are well taught m all the details of childbirth and its complications, and I also know, from long experience, that you carry out these directions m a most satisfactory manner. Complications, however, will crop up, and these require special skill to combat them. There is no more serious complication can arrive m your work than that of ophthalmia neonatorum, which is a septic inflammation of the lids and eyes of the newly-born. What makes this trouble more serious, at any rate from a nurse's point of view, is that m the majority of cases it is preventable. Fortunately its virulence, if treated at once, can be checked, and that before any serious complications ensue. It is a terrible tragedy to contemplate that a newly-born child, with beautiful clear eyes, may be made permanently blind m a few days if the greatest care is not taken. In every normal labour, as you all know, there is a profuse discharge from the mother, called the lochia. This is a natural discharge which conies from the womb. But mixed with this discharge you get other discharges which have been lodging m the passages; so that what should have been a pure discharge is now mixed with septic matter. These septic discharges are full of germs, and these germs vary m virulence — some are fairly harmless, but others are very virulent. Therefore it naturally follows, when the child is being 1 born, its whole body gets covered with these germs, and they lodge m all the folds or crevices. The places where they do lodge, which particularly concern us, are round about the eyes, on

the eyebrows, and the eyelashes. When a child is being born the eyes may be open immediately before birth or during birth, or the eyes may be closed when born. HOW THE EYES BECOME INFECTED. In the first case, the germs can easily get into the eyes; but, m the second case, they cannot get into the eyes until they open later. Jt is the duty of the nurse to see for herself what has happened and act accordingly. If the child is born with the eyes open and the discharges running all over its face, the nurse must immediately proceed to give this her special attention. I fully realise that it is often difficult to do this at once. The cord has to be tied, there may be excessive haemorrhage, and the mother may demand all your attention. Moreover, probably you are m a wretched room, with no one capable of assisting you. There are, therefore, many difficulties to contend with; but it comes to this, that, once having noticed the condition, you will at the very earliest moment attend to these little eyes. The term "delays are dangerous" can never be bet ter illustrated than m connection with this position. THE NATURE OF VIRULENT DISCHARGES: Now let us go back a little and see what these septic and virulent discharges are; Every woman must have m her vagina, more or less, germs of a septic nature. They may be quite simple m their action, and do little or no harm, but at the same time they may be sufficiently virulent to set up inflammation m the delicate eye of a newly-born infant, which at first maj resemble the more severe forms pi septic inflammation! These, however, readily give way to treatment m a few days. Now the most dangerous of all these germs to the baby's eye is known as the g6nococcus. Gonorrhoea, as you all know, is a venereal disease, and is set up by the goriococcus. This germ lodges m the

folds of the vagina and round about the cervix, and if it gets into the child's eye disastrous results will follow. The epithelium covering a baby's eye is very fine and delicate, and if attacked by such a germ inflammation is quickly set up. The conjunctiva over the lids become swollen and infected, and the infection gradually spreads all over the eye ; pus forms very ripidly, and then all the characteristic symptoms are set up. An eye can be destroyed m 24 hours if it is a particularly virulent germ, and more especially if the case is neglected. ROUTINE TREATMENT IN HOSPITAL. The ophthalmia neonatorum work was first started m St. Paul's Hospital m 1908 under a systematic method. Its success and usefulness was such that official municipal recognition soon took place, which lesulted m the co-operation of the Liverpool Corporation Health Department an 3 the hospital. We began with four beds, but now we tan take m 10 mothers and their babies, besides seeing a number of cases of a mi id character m a special dressing-room m the out-patient department. The routine. is as follows: As soon as a midwife notices any discharge m tae baby's eyes, or is even suspicious that they are not w T ell, she at once notifies the medical officer of health. Ophthalmia neonatorum being a notifiable disease, a speci-ally-trained nurse is sent by the Health Department to investigate the case, and if she considers it necessary she notifies both the health authorities and the hospital. The child is then sent to the hospital, where it is seen by the surgeon on duty, who gives directions as to whether it is to be treated as an out-patient or admitted to hospital. If it is decided that it is to be admitted, the authorities send an ambulance car, and mother and baby are brought without delay. The mother is thus m a position to continue nursing her child, and the child gets the benefit of the mother's personal care, and more particularly is able to be breast-fed — one of the principal features of the treatments. The municipal authorities give a grant for every child which comes under

treatment. When the child is first seen a film of the discharge is immediately taken, stained, and examined, and the natnre of the germ noted and entered m the special ophthalmia neonatorum book. Probably about 60 or 70 per cent, are gouococcal, but there are also other mixed infections. If cases have been treated outside before admission, it is not always possible to find the germ, or say definitely which germ is causing the trouble. As long as the case is serious all cases are admitted irrespective of the special kind of germ found. , The treatment consists of constant and regular douching every two hours, and afterwards using drops of varying strengths. The douche may be one of a solution of sod. bicarb. 3j. to Oj., which docs good by dissolving away the discbarge, and very good results have been obtained. But the douche is constantly varied, attempts being made all the time to obtain something yet more efficient. At present we are using satisfactorily a weak solution of acraflavine. The drops used at present are chiefly argyrol m varying percentage — anything from 5 to 50 per cent., according to the case. Chloride of zinc is also excellent — ■ | to 1 gr. to loz. If the lids are much swollen and tender, cooling lotions are applied, such as lotio plumbi subacetatis co. spt. Tire insides of the lids are sometimes painted with nitrate of silver — gr. ii. to loz. — if there is much rugosity. The mothers have at their side a small bowl of lotion and some dabs of cottonwool, so that they can wipe away any excess discharge which may form between the douching'S. The period of stay m hospital is anything from two to six or eight weeks, but one can often allow a mild case to be discharged and treated m the outpatient department. Cases treated m the out-patient department — where there is a special dressing-room appointed for them — are of the milder type, and they are brought by a friend once or twice a day for treatment at specified times. In 1918, 278 cases were sent to St. Paul's Hospital for treatment, Of these, 251 were absolutely cured. The eyes of 14 were dam-

aged, but the children were not blind; two were blind, and seven died before they could be cured. TREATMENT BY MIDWIVES. In conclusion I should like to say a few words with regard to the treatment and care of the cases from the midwife's point of view. When attending a midwifery case pay particular attention to everything about you and around you. Secure strict cleanliness of persons and clothing ; have your hands, especially the nails, well washed and scrubbed; the bedclothes, towels, and utensils as clean as possible ; your patient thoroughly cleansed about the vulva, pubes, etc., with soap and clean boiled Avater. Have a bowl of antiseptic'

lotion and plenty of absorbent wool swabs ready to wash the face and eyes of the newly-born child. If the eyes are open, wash out with the lotion; if closed, wash Iho eyelids, eyebrows, and eyelashes. Use a clean swab each time; don't keep dipping the used swab into the lotion. Never wash the face or eyes with the water with which you wash the body. Keport at once any sign of inflammation or pus, or discharge of any kind. Do not attempt to treat the case yourself. If removal to hospital has been advised, explain to the mother the dangers of the disease, and the necessity of having the baby breast-fed. — * ' The Nursing Mirror and Midwives ' Journal."