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

International audience ; IntroductionEarly onset neonatal sepsis is a rare but potentially lethal affection which is very oftensuspected. Previous national guidelines recommended the use of systematic paraclinictests for healthy newborns with suspected infection. These guidelines have beenupdated in 2017 by the French Haute Autorité de Santé, and promote initial clinicalmonitoring taking into account the infectious risk level for term and near term borninfants.ObjectivesTo assess the impact of the new recommendations on antibiotic therapy prescriptionand on the outcomes of infants born from 36 weeks gestation.Materials and methodsThis study compared the management and the outcome of neonates born from 36weeks gestation in the level III University Hospital of Nancy, according to theirinfectious risk level during two periods, before and after the update of nationalrecommendations: from July 1 st to December 31 st 2017, versus July 1 st toDecember 31 st 2018. Data were retrospectively collected in the infants’ file. Thisstudy compared mortality, the number of documented infections, the number ofinvasive tests, the number and length of hospitalization between the two periods.ResultsDuring the first period, among 1248 eligible newborn, 643 presented an infectious riskfactor, versus 1152 newborn with 343 having an infectious risk factor during thesecond 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 theantibiotic treatment was longer in the first than in the second period: 6.3 +/- 2 days, vs3.1 +/- 2.3 days (p = 0.003). There was no death related to neonatal infection. Onethousand and fifty-two blood samples were done in the first period versus 51 in thesecond (p < 0.01). There was no documented infection. In the first period, there were18 newborns (1.4%) hospitalized for suspicion of infection versus 9 (0.8%) in thesecond (P=0.13). The duration of hospitalization was 5.7+/- 1.7 days in the first ...