P Sikias1, C Parmentier2, P Imbert3, M Rajguru4, M-S Chavet2, S Coquery5, L Foix-L'Hélias6, P Boileau7. 1. Maternité, hôpital privé d'Antony, 1, rue Velpeau, 92160 Antony, France. Electronic address: ppsikias@free.fr. 2. Service de néonatologie, hôpital Trousseau, AP-HP, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France. 3. Fédération maternité-pédiatrie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France. 4. Service de néonatologie, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France. 5. Maternité, institut hospitalier franco-britannique, 4, rue Kléber, 92300 Levallois-Perret, France. 6. Service de néonatologie, hôpital Trousseau, AP-HP, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre et Marie Curie, 75012 Paris, France. 7. Service de médecine et réanimation néonatales, CHI Poissy St-Germain-en-Laye, 10, rue du Champ-Gaillard, 78300 Poissy, France; EA 7285, université Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France.
Abstract
INTRODUCTION: Early-onset neonatal infection remains a major cause of morbidity and mortality in neonates. Both universal vaginal screening for group-B streptococcus (GBS) and intrapartum antibiotic prophylaxis have decreased the incidence of early-onset GBS disease. Almost 12 years after the implementation of the French recommendations, we assessed the practices around screening, diagnosis, and treatment of early-onset neonatal infection in the Île-de-France region. PATIENTS AND METHODS: We conducted a prospective, multicenter, observational study in 14 volunteer maternity wards from 18 to 31 March 2013. All live newborn infants delivered at 35 gestational weeks or more were eligible. Maternal, obstetrical, and neonatal characteristics were collected, as well as the management of suspected early-onset neonatal infections. RESULTS: A total of 1194 mothers and 1217 neonates were included. Among the latter, 54% had bacteriological samplings at birth, with at least a gastric aspirate. Bacteriological samples were collected at birth in 85% of cases based on major or minor anamnestic infection criteria defined by the French National Authority for Health in 2002. In addition, 26% of neonates had at least one blood sample taken. Antibiotic treatment was administered in 4% of the infants with cefotaxime administered in two thirds of cases. CONCLUSION: An update of the French guidelines for the management of early-onset neonatal infections is required in order to improve targeting of newborn infants suspected of having an infection and to optimize the antibiotics administered. Moreover, the role of bacteriological sampling at birth needs to be clarified.
INTRODUCTION: Early-onset neonatal infection remains a major cause of morbidity and mortality in neonates. Both universal vaginal screening for group-B streptococcus (GBS) and intrapartum antibiotic prophylaxis have decreased the incidence of early-onset GBS disease. Almost 12 years after the implementation of the French recommendations, we assessed the practices around screening, diagnosis, and treatment of early-onset neonatal infection in the Île-de-France region. PATIENTS AND METHODS: We conducted a prospective, multicenter, observational study in 14 volunteer maternity wards from 18 to 31 March 2013. All live newborn infants delivered at 35 gestational weeks or more were eligible. Maternal, obstetrical, and neonatal characteristics were collected, as well as the management of suspected early-onset neonatal infections. RESULTS: A total of 1194 mothers and 1217 neonates were included. Among the latter, 54% had bacteriological samplings at birth, with at least a gastric aspirate. Bacteriological samples were collected at birth in 85% of cases based on major or minor anamnestic infection criteria defined by the French National Authority for Health in 2002. In addition, 26% of neonates had at least one blood sample taken. Antibiotic treatment was administered in 4% of the infants with cefotaxime administered in two thirds of cases. CONCLUSION: An update of the French guidelines for the management of early-onset neonatal infections is required in order to improve targeting of newborn infants suspected of having an infection and to optimize the antibiotics administered. Moreover, the role of bacteriological sampling at birth needs to be clarified.