Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France.
Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France.
Arch Pediatr. 2021 Feb;28(2):117-122. doi: 10.1016/j.arcped.2020.11.009. Epub 2021 Jan 11.
Early-onset neonatal sepsis is a rare but potentially lethal infection that is very often suspected in daily practice. Previous national guidelines recommended the use of systematic paraclinical tests for healthy term newborns with suspected infection. These guidelines were updated in 2017 by the French Health Authority (Haute Autorité de santé), and promote initial clinical monitoring taking into account the infectious risk level for term and near-term born infants.
To assess the impact of the new recommendations on antibiotic therapy prescription and invasive tests, and on the outcomes of infants born from 36weeks' gestation.
This study compared the management and the outcome of neonates born from 36weeks' gestation at 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 to December 31, 2017, versus July 1 to December 31, 2018. Data were retrospectively collected from the infants' files. This study compared the number and length of antibiotic treatment and the number of invasive tests, the number of documented infections, the number and length of hospitalization, and mortality between the two periods.
During the first period, among 1248 eligible newborns, 643 presented an infectious risk factor, versus 1152 newborns 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 for nine 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±2days vs. 3.1±2.3days (P=0.003). There was no death related to neonatal infection. A total of 1052 blood samples were collected during the first period versus 51 during the second (P<0.01). There was no documented infection. In the first period, there were 18 newborns (1.4%) hospitalized for suspected infection versus nine (0.8%) in the second period (P=0.13). The duration of hospitalization was 5.7±1.7days in the first period versus 5.2±3days in the second (P=0.33).
In this study, the application of the new guidelines enabled a reduction of antibiotic exposure and a reduction of invasive tests without additional risk.
早发性新生儿败血症是一种罕见但潜在致命的感染，在日常实践中经常被怀疑。以前的国家指南建议对疑似感染的健康足月新生儿进行系统的辅助检查。这些指南在 2017 年被法国卫生当局（Haute Autorité de santé）更新，提倡根据足月和近足月出生婴儿的感染风险水平，进行初始临床监测。
评估新建议对抗生素治疗处方和侵入性检查以及 36 周出生婴儿的预后的影响。
本研究比较了三级大学医院 Nancy 水平的 36 周出生婴儿在两个时期的管理和结局，根据其感染风险水平：更新国家指南之前（2017 年 7 月 1 日至 12 月 31 日）和之后（2018 年 7 月 1 日至 12 月 31 日）。数据从婴儿档案中回顾性收集。本研究比较了两个时期之间的抗生素治疗数量和长度、侵入性检查数量、有记录的感染数量、住院时间和死亡率。
在第一个时期，在 1248 名合格的新生儿中，有 643 名出现感染风险因素，而在第二个时期，有 1152 名新生儿中有 343 名出现感染风险因素。第一个时期有 18 名新生儿开始使用抗生素（1.4%），第二个时期有 9 名（0.8%）（P=0.13）。第一个时期的抗生素治疗时间比第二个时期长：6.3±2 天比 3.1±2.3 天（P=0.003）。没有与新生儿感染相关的死亡。第一个时期共采集 1052 份血样，第二个时期采集 51 份（P<0.01）。没有记录到感染。在第一个时期，有 18 名（1.4%）新生儿因疑似感染住院，第二个时期有 9 名（0.8%）（P=0.13）。第一个时期的住院时间为 5.7±1.7 天，第二个时期为 5.2±3 天（P=0.33）。
在这项研究中，新指南的应用使抗生素暴露减少，并减少了侵入性检查，而没有增加额外的风险。
