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Term newborns at risk for early-onset neonatal sepsis: Clinical surveillance versus systematic paraclinical test

Abstract : 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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C. Schmitt, Marion Novy, J.M. Hascoët. Term newborns at risk for early-onset neonatal sepsis: Clinical surveillance versus systematic paraclinical test. Archives de Pédiatrie, Elsevier, 2021, 28 (2), pp.117-122. ⟨10.1016/j.arcped.2020.11.009⟩. ⟨hal-03258952⟩



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