Dear Colleague Letter: Clarify Certain Newborn Treatments Requirements - Eye Prophylaxis, Vitamin K, Breastfeeding Guidance, March 23, 2011

March 23, 2011

Dear Colleague:

The purpose of this letter is to clarify the requirements regarding certain newborn treatments - Eye Prophylaxis and Vitamin K - and provide guidance regarding the provision of these medications in a manner supportive of breastfeeding.

Eye Prophylaxis

Under Section 12.2 of the Compilation of the Rules and Regulations of the State of New York (NYCRR) Title 10, it is the duty of the attending physician, licensed midwife, licensed nurse or other authorized provider in attendance at delivery to place into the eyes of the infant, on delivery, an agent effective for preventing purulent conjunctivitis of the newborn, such as erythromycin eye ointment.

Eye prophylaxis is given to prevent gonococcal infection of the eyes. This infection was once a common cause of blindness and has now been almost entirely eradicated through the use of prophylactic medications. Eye prophylaxis is a universal requirement because the treatment is effective and safe. Moreover, targeted prophylaxis, treating only infants of mothers known to be infected with gonorrhea, is not an effective approach to prevention. This infection is found among women of childbearing age and the organism can be difficult to culture. Targeted prophylaxis would miss many infants and lead to many cases of preventable blindness. Erythromycin eye ointment has minimal side-effects and is highly effective.

Vitamin K

Under Section 12.3 of NYCRR Title 10, it is the duty of the attending physician, licensed midwife, registered professional nurse or other licensed medical professional attending the newborn to assure administration of a single parenteral dose of 0.5-1.0 mg of Vitamin K1 oxide (phytonadione) within one hour of birth.

Vitamin K is given within an hour of birth to prevent hemorrhagic disease of the newborn, a potentially fatal condition. It must be given by injection. Oral Vitamin K is not as effective as Vitamin K by injection. Vitamin K prophylaxis is mandated for all newborns because the condition it prevents is life-threatening and because of the intervention is very safe.

Breastfeeding

Breastfeeding has a significant impact on improving the health of infants and mothers. Breastfeeding has been associated with a reduction in the risk of acute otitis media, asthma in young children and chronic diseases, including obesity and diabetes, later in life. Breastfeeding also has a significant health benefits to the mother such as reducing postpartum bleeding and may lower the risk of breast and ovarian cancer, and contributes economic benefits to the family.

One of the keys to successful breastfeeding is to ensure that newborn babies are placed in their mother's arms or on the mother's chest, skin-to-skin, within the first half-hour after birth, and held there for at least 30 minutes. To promote breastfeeding, eye prophylaxis and Vitamin K administration may be delayed up to 1 hour to allow for uninterrupted mother-infant skin-to-skin contact and breastfeeding. Unless contraindicated due to the health of the mother or newborn, mothers should be supported to initiate breastfeeding within one hour of birth. We encourage you to review your hospital's policies and procedures to ensure they are in conformance with this practice, and be sure your staff understands the importance of supporting new mothers to breastfeed within 1 hour of delivery, as well as throughout their stays in the hospital.

It is important to note that although the administration of these medications may be delayed until after the first breastfeeding has occurred, the provision of these medications is not voluntary on the part of the parent(s). Though hospitals are encouraged to provide options for labor, delivery and post-partum services, health care personnel should explain to any objecting parent that the administration of eye prophylaxis and Vitamin K are mandated by NYCRR Title 10. It may also be helpful to have an attending Obstetrician or Pediatrician who has rapport with the parent(s) explain the purpose and need for the procedures. These treatments represent the standard of care recommended by the American Academy of Pediatrics1,2 and the American College of Obstetricians and Gynecologists2. Should the parent(s) continue to refuse the newborn treatments, the matter should be discussed with your facility's legal counsel.

Should you have any questions please contact Christopher Kus, MD, MPH at 518-473-9883.

Sincerely,

Marilyn A. Kacica, M.D., M.P.H.
Medical Director
Division of Family Health
Mary Ellen Hennessy
Director
Division of Certification and Surveillance
  • 1. American Academy of Pediatrics, Committee on Fetus and Newborn. Controversies concerning Vitamin K and the newborn. Pediatrics. 2003; 112:191-192
  • 2. American Academy of Pediatrics, American College of Obstetricians and Gynecologists Guidelines for Prenatal Care. 6th Edition. 2007