Silver Nitrate in the Baby’s Eyes – Is It Really Necessary?

Throughout pregnancy, one of women’s biggest concerns is about childbirth. Whether it will be vaginal, humanized, or cesarean, and how it will be or how they’ll feel during that moment. But what most people don’t know is what happens to the baby right after birth and the procedures they are routinely subjected to in their first minutes of life. One of these procedures is the application of silver nitrate to the newborn’s eyes to prevent conjunctivitis, gonococcal infections, and chlamydia, which can be transmitted during delivery¹.

This procedure became mandatory in Brazil in 1977 by order of the Ministry of Health after a large outbreak of infant blindness at the time, due to conjunctivitis caused by the gonorrhea bacteria², which was a very common disease back then. This measure greatly reduced the number of affected babies and has therefore been continued to the present day, both in Brazil and around the world.

The big problem is that using silver nitrate in the newborn’s eyes can cause chemical conjunctivitis, severe eye irritation, as well as being extremely painful, burning the baby’s eyes, and even staining their skin when it is applied. Here’s the question! If gonorrhea isn’t so common these days and can be detected through exams during prenatal care, why should babies still undergo such a painful procedure? Is it really necessary?

Another much-discussed point relates to the mode of birth. If a baby’s contact with the gonococcal bacteria happens during a vaginal birth, why is silver nitrate also applied to babies born via cesarean section? According to pediatricians and neonatologists, the answer is that in the event of ruptured membranes or placental rupture, there is a risk the baby can become contaminated, even during a cesarean birth.

What few mothers also know is that they can refuse the use of silver nitrate eye drops by signing a liability waiver in the maternity hospital, declining the procedure and potentially attaching prenatal test results proving the absence of the bacteria, which serve as justification for suspending the procedure.

To Use or Not Use Silver Nitrate in Newborns?

It’s true that applying silver nitrate to newborns’ eyes significantly reduced the number of children who became blind after this measure was adopted, and that’s a fact. However, according to some specialists, silver nitrate is not 100% effective against gonococcal and chlamydia bacteria, as some strains of chlamydia show some resistance to silver nitrate. In these cases, it is necessary to combine silver nitrate with other medications to fight the bacteria.

The use of silver nitrate in newborns can also cause toxic conjunctivitis³ within the first 48 hours of life; if it doesn’t resolve within this period, it’s considered neonatal conjunctivitis. In this case, in addition to the newborn, the mother should take extra care not to become infected as well. Contrary to popular belief, conjunctivitis is not airborne, but transmitted by contact. Therefore, a mother’s hands should be carefully washed after cleaning the baby’s eyes.

If silver nitrate is not applied immediately after birth and the baby comes into contact with bacteria and develops conjunctivitis caused by gonococcus, blindness can occur within a matter of hours, totally and irreversibly. During the procedure of applying silver nitrate to newborns, it is possible to minimize the risks and harm it can cause. The solution can be wiped away with cotton or gauze right after administration, removing excess and preventing it from accumulating and damaging the sensitive skin around the eyes.

If you have questions about the procedure and want clarification before the day of delivery, talk to your obstetrician to find out what to do at the maternity hospital. If possible, do all necessary tests during prenatal care to rule out the presence of the bacteria and present them on the day of delivery to avoid the use of the product, should that be your choice.