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Application of HAS 2017 guidelines for asymptomatic neonates born at ? 34 weeks’ gestation at risk of early-onset neonatal sepsis in a level-2 maternity department - 12/01/21

Doi : 10.1016/j.arcped.2020.12.007 
B. Cabaret a, , V. Latry b
a Pediatric department, CH de Bigorre, boulevard de Lattre-de-Tassigny, 65000 Tarbes, France 
b Research department, CH de Bigorre, boulevard de Lattre-de-Tassigny, 65000 Tarbes, France 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 12 January 2021

Abstract

The 2017 Haute Autorité de santé (HAS) guidelines for the medical care of neonates born at34 weeks’ gestation (WG) at risk of early-onset neonatal sepsis (EONS) placed emphasis on clinical examination rather than laboratory tests.

Aim

Were these guidelines relevant in our level-2 maternity department, and how can they affect our professional practice?

Methods

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.

Results

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.

Conclusion

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.

Le texte complet de cet article est disponible en PDF.

Keywords : Early-onset neonatal sepsis, Asymptomatic newborns, Clinical assessment, Level-2 maternity department


Plan


 This study was presented in “Journées françaises de la recherche en néonatologie” as an oral communication in December 2019.


© 2020  French Society of Pediatrics. Publié par Elsevier Masson SAS. Tous droits réservés.
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