Prophylaxe der Ophthalmia neonatorum

Prophylaxis of ophthalmia neonatorum

Zusammenfassung

Die WHO definiert die Neugeborenen-Konjunktivitis als eine Bindehautentzündung, die innerhalb der ersten 4 Lebenswochen auftritt. Verursacher sind in der Regel Mikroben wie Bakterien oder Viren, aber auch allein durch die toxische Wirkung lokal applizierter Substanzen können Reizzustände des äußeren Augenabschnittes auftreten. Erreger einer bakteriell bedingten Ophthalmia neonatorum sind in der „ersten“ Welt vorwiegend Chlamydien und Staphylokokken. Die Prävalenz der durch Neisseria gonorrhoeae hervorgerufenen Ophthalmia neonatorum (ON) ist in den industrialisierten Ländern zwar sehr niedrig (0,04%), weist jedoch ein potentiell sehr hohes Erblindungsrisiko auf. Daher muss eine Prophylaxe diesen virulenten Keim unbedingt miteinschließen. In jüngerer Zeit ist die Prophylaxe der ON mittels Instillation von 1% Silbernitrat (Credé 1881) umstritten. Vielfach werden bereits andere Antiseptika — wie Polyvidon-Jod 2,5% — oder verschiedenste Antibiotika — wie Erythromycein oder Tetrazykline — als Alternativen vorgeschlagen und verwendet. Die — entsprechend dem Ergebnis der durchgeführten Konsensus-Veranstaltung — zur Zeit nachgewiesen effizienteste Substanz zur Prophylaxe der ON stellt Polyvidon-Jod 2,5% dar, sie sollte deshalb auf allen Neugeborenen-Stationen eingesetzt werden.

Summary

Conjunctivitis of the newborn is defined as any conjunctivitis that occurs within the first 4 weeks of life. Neonatal conjunctivitis is caused by a bacterial, viral or chlamydial infection, or by a toxic response to topically applied chemicals. The causative agents that most frequently responsible for ophthalmia neonatorum in the “first” world are Chlamydia trachomatis and Staphylococci. Gonococcal ophthalmia neonatorum still remains a problem — although a rarer one — affecting approximately 0.04% of neonates in industrialized countries. Because of the potentially high risk of blindness with this agent, any type of prophylaxis has to cover this virulent germ. The usage of silber nitrate at a concentration of 1 % — as it has been introduced by Credé in 1881 — has been criticized for the frequent chemical conjunctivitis and its incomplete protection against chlamidia. To avoid these problems other antiseptics — e.g. povidone-iodine — or such as tetracycline and erythromycine, have been substituted for silver nitrate. According to the results of the recently held consensus-meeting povidone-iodine 2.5% is present to be considered the substance of choice for the prophylaxis of newborns against ophthalmia neonatorum and should be used on wards for the newborn.

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Correspondence to S. F. Egger.

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Herrn Prof. Freyler zum Geburtstag gewidmet.

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Egger, S.F., Huber-Spitzy, V. Prophylaxe der Ophthalmia neonatorum. Spektrum Augeheilkd 14, 159–162 (2000). https://doi.org/10.1007/BF03163075

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Schlüsselwörter

  • Ophthalmia neonatorum
  • Prophylaxe
  • Polyvidon-Jod

Key words

  • Ophthalmia neonatorum
  • prophylaxis
  • povidone-iodine