Pediatric department, CH de Bigorre, boulevard de Lattre-de-Tassigny, 65000 Tarbes, France.
Research department, CH de Bigorre, boulevard de Lattre-de-Tassigny, 65000 Tarbes, France.
Arch Pediatr. 2021 Feb;28(2):159-165. doi: 10.1016/j.arcped.2020.12.007. Epub 2021 Jan 11.
The 2017 Haute Autorité de santé (HAS) guidelines for the medical care of neonates born at≥34 weeks' gestation (WG) at risk of early-onset neonatal sepsis (EONS) placed emphasis on clinical examination rather than laboratory tests.
Were these guidelines relevant in our level-2 maternity department, and how can they affect our professional practice?
Single-site observational study of asymptomatic 35 WG neonates at risk of EONS, born in the centre hospitalier de Bigorre, with follow-up analysis during two 5-month periods (from September 2017 to January 2018, and September 2018 to January 2019), before and after the publication of the HAS guidelines. The main objective was feasibility, evaluated by checking the completion of a standardised assessment chart. The second objective was the impact of the guidelines on professional practices evaluated by the number of laboratory tests carried out during the two periods.
Out of 455 births during the first period and the 396 births during the second, 78 (17,1%) and 50 (12,6%) newborns, respectively, at risk of EONS were included. Those two groups had statistically similar characteristics. Overall, 49 (98%) assessment charts were satisfactorily completed for the 50 newborns. The number of laboratory tests decreased significantly (P<0.01): During the first period, all the newborns (78, 100%) had a C-reactive protein (CRP) test and 66 (84,6%) had a gastric fluid culture, versus one (2%) CRP and three (6%) gastric fluid cultures during the second period.
The HAS guidelines, emphasising repeated clinical assessment of newborns at risk of EONS rather than laboratory, were considered to be feasible in our maternity department. They led to an improvement in our professional practices and a reduction in laboratory procedures.
这些指南在我们的二级产科病房是否适用，以及它们如何影响我们的专业实践？
对在比利牛斯山中心医院出生、有发生早发性新生儿败血症（EONS）风险的 35 周+的无症状 35 周+的新生儿进行单中心观察性研究，在 HAS 指南发布前后，通过对两个 5 个月时期（2017 年 9 月至 2018 年 1 月和 2018 年 9 月至 2019 年 1 月）的新生儿进行随访分析。主要目标是通过检查标准化评估图表的完成情况来评估可行性。第二个目标是通过在两个时期进行的实验室检查数量来评估指南对专业实践的影响。
在第一个时期的 455 例分娩和第二个时期的 396 例分娩中，分别有 78 例（17.1%）和 50 例（12.6%）有发生 EONS 风险的新生儿。这两组的特征具有统计学上的相似性。总的来说，50 例新生儿中有 49 例（98%）的评估图表完成得令人满意。实验室检查的数量显著减少（P<0.01）：在第一个时期，所有新生儿（78 例，100%）都进行了 C 反应蛋白（CRP）检查，66 例（84.6%）进行了胃液培养，而第二个时期只有 1 例（2%）进行了 CRP 检查和 3 例（6%）进行了胃液培养。
HAS 指南强调对有发生 EONS 风险的新生儿进行反复的临床评估，而不是实验室检查，在我们的产科病房被认为是可行的。它们导致了我们的专业实践的改进和实验室程序的减少。
