title: A double application approach to ophthalmia neonatorum prophylaxis.
abstract: OBJECTIVE
  To investigate if a second drop of 2.5% povidone-iodine ophthalmic solution placed within the first postnatal day would achieve better prophylaxis against ophthalmia neonatorum than a single drop applied at birth.
  
  
  METHODS
  A masked, prospective, controlled trial was conducted over a 2 year period in a Kenyan hospital. Randomisation was achieved by alternating weeks of one or two eye drop application to both eyes. All 719 neonates received one drop of the povidone-iodine solution to both eyes at birth, while 317 received a second drop at hospital discharge or 24 (SD 4) hours after delivery, whichever was first. All infants developing conjunctivitis within a month after birth underwent microbiological analysis using Gram and Giemsa stains, direct fluorescent antibody assay for Chlamydia trachomatis, and culture.
  
  
  RESULTS
  Of the neonates receiving the one eye drop application, 18.4% returned with a red eye with discharge, 4.0% had organisms found on the initial smear, and 8.2% had a positive culture. The corresponding proportions for the multidrop group were 24.3%, 4.7%, and 10.4%. Of those returning with an inflamed eye, there were no cases of Neisseria gonorrhoeae, 4.2% in the single dose group and 3.9% in the double dose group were positive for C trachomatis, and 5.4% and 6.5% respectively for Staphylococcus aureus. At discharge, the eyelid oedema score of the double dose group was mildly greater than the single dose group (1.4 (0.67) v 1.2 (0.73), p=0.0002). There was no statistically significant difference between the groups in any other category.
  
  
  CONCLUSIONS
  There is no advantage to administering povidone-iodine prophylaxis against ophthalmia neonatorum twice in the first postnatal day over a single application at birth.
authors.affiliation: Jules Stein Eye Institute, Department of Ophthalmology, Research and Education Institute at Harbor-UCLA Medical Center, Torrance, CA 90509, USA. isenberg@ucla.edu
authors.forename: S J
authors.initials: SJ
authors.lastname: Isenberg
authors.forename: L
authors.initials: L
authors.lastname: Apt
authors.forename: M
authors.initials: M
authors.lastname: Del Signore
authors.forename: S
authors.initials: S
authors.lastname: Gichuhi
authors.forename: N G
authors.initials: NG
authors.lastname: Berman
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002690:Chlamydia Infections / Q000175:diagnosis; D003906:Developing Countries; D004334:Drug Administration Schedule; D004487:Edema / Q000139:chemically induced; D005141:Eyelid Diseases / Q000139:chemically induced; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D009878:Ophthalmia Neonatorum / Q000517:prevention & control*; D009883:Ophthalmic Solutions; D011206:Povidone-Iodine / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies
chemical_list: D000891:Anti-Infective Agents, Local; D009883:Ophthalmic Solutions; D011206:Povidone-Iodine