Term newborns at risk for early-onset neonatal sepsis: Clinical surveillance versus systematic paraclinical test
Résumé
Introduction
Early onset neonatal sepsis is a rare but potentially lethal affection which is very often
suspected. Previous national guidelines recommended the use of systematic paraclinic
tests for healthy newborns with suspected infection. These guidelines have been
updated in 2017 by the French Haute Autorité de Santé, and promote initial clinical
monitoring taking into account the infectious risk level for term and near term born
infants.
Objectives
To assess the impact of the new recommendations on antibiotic therapy prescription
and on the outcomes of infants born from 36 weeks gestation.
Materials and methods
This study compared the management and the outcome of neonates born from 36
weeks gestation in the level III University Hospital of Nancy, according to their
infectious risk level during two periods, before and after the update of national
recommendations: from July 1 st to December 31 st 2017, versus July 1 st to
December 31 st 2018. Data were retrospectively collected in the infants’ file. This
study compared mortality, the number of documented infections, the number of
invasive tests, the number and length of hospitalization between the two periods.
Results
During the first period, among 1248 eligible newborn, 643 presented an infectious risk
factor, versus 1152 newborn with 343 having an infectious risk factor during the
second period. Antibiotic treatment was initiated for 18 newborns during the first period
(1.4%) and 9 during the second (0.8%) (p = 0.13). The mean (SD) duration of the
antibiotic treatment was longer in the first than in the second period: 6.3 +/- 2 days, vs
3.1 +/- 2.3 days (p = 0.003). There was no death related to neonatal infection. One
thousand and fifty-two blood samples were done in the first period versus 51 in the
second (p < 0.01). There was no documented infection. In the first period, there were
18 newborns (1.4%) hospitalized for suspicion of infection versus 9 (0.8%) in the
second (P=0.13). The duration of hospitalization was 5.7+/- 1.7 days in the first period
versus 5.2 +/- 3 days in the second (p = 0.33).
Conclusion
The application of the new guidelines enables a reduction of antibiotic exposure
without additional risk
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