BackgroundEarly-onset neonatal sepsis (EOS) is a rare condition but an important cause of severe morbidity and mortality in neonates.MethodsThis is a prospective observational study in neonates born at ≥34 weeks of gestation (WG). The primary endpoint was EOS, defined by isolation of pathogenic species from blood culture and/or cerebrospinal fluid culture within 72 hours after birth. Data on EOS were collected exhaustively from all maternity wards in Paris area (April 2019–March 2021).Results108 EOS were recorded (annual incidence, 0.32 per 1000 live births; 95% CI 0.26 to 0.38). In term infants, the most frequent pathogens were group B Streptococcus (GBS) (n=47) and Escherichia coli (n=20); in late preterm infants, the most frequent pathogens were E. coli (n=15) and GBS (n=7). Fifteen meningitis cases were diagnosed. Five E. coli strains (14%) were resistant to both amoxicillin and gentamicin, which is an empiric treatment for EOS. Of the 54 infants with GBS infections, 35 were born from mothers with negative GBS prepartum screening test and 8 from mothers with no screening. Two deaths were reported, both in term infants (Proteus mirabilis and E. coli).ConclusionIn neonates ≥34 WG born in the Paris area, GBS was twice as frequent as E. coli in term infants. EOS was six times more frequent in late preterm than in term infants and was due to E. coli in 60% of cases. Prevention of GBS EOS and empiric antibiotic treatment of EOS could be improved.
La durée moyenne de séjour en maternité a fortement diminué en 40 ans. En 2014, l'HAS définit comme précoce toute sortie survenant avant 72 heures pour un accouchement par voie basse et avant 96 heures pour une césarienne. Insuffisamment préparée, la sortie précoce peut exposer le nouveau-né à une morbidité élevée et des retards de diagnostic. Elle doit donc être réservée à une population à bas risque médical, social et psychologique. L'adhésion des parents au projet est indispensable, tout comme la qualité du suivi à domicile et l'accès approprié aux soins posthospitaliers.
Mots clés Sortie précoce · Postpartum · Nouveau-néAbstract The postpartum hospital stay has strongly decreased in the last 40 years. In 2014, the HAS defined an early postnatal discharge as occurring before 72 hours for a vaginal delivery and before 96 hours for a caesarian section. An early discharge with insufficient planning can expose the newborn to higher morbidity and delayed diagnosis; it must thus be reserved for a population at low risk for medical, social and psychological complications. Approval of the parents to the project is essential, as well as the quality of home visits and suitable access to follow-up care.
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