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Master Thesis

Évaluation des pratiques professionnelles sur les recommandations concernant l’infection néonatale bactérienne précoce et leurs conséquences chez les nouveau-nés

Abstract : Introduction: Guidelines for the management of neonatal newborn at risk of early onset neonatal infection (≥ 34 gestational weeks) were published in 2017. Their objective was not missing a case of early-onset infection and to decrease: bacteriological gastric fluid analyses, bacteriological and blood samples, and the number and duration of probabilistic antibiotics as well as the triple associations of antibiotics in relying a clinical monitoring in maternity ward. Objective: To assess the practices of professionals following the implementation of the 2017 guidelines. Analyze the implications of implementing these newborn recommendations comparatively to the 2002 clinical guidelines. Material and method: We conducted a retrospective comparative study on medical records conducted at the Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye. All live newborn infants delivered at 36 gestational weeks or more from March 18 to 31, in 2013 and 2019 were included. Maternal, obstetrical, and neonatal characteristics were collected, as well as the management of suspected of early-onset neonatal infections. Results: A total of 302 mothers and 308 neonates were included. Among those,172 newborn were retained and analyzed in 2013 and 136 in 2019. In 2019, there were: 27% of adequate per and post-partum antibiotic administrations, 84% of adequate birth classifications (p < 0,01) and 94% of monitoring adapted to the risk level of infection (p < 0,01). In 2013, 58% of newborns had bacteriological samples (analysis of the gastric fluid and two peripheral samples) compared to none in 2019 (p < 0,01). Five percent were taken for at least one C-reactive protein analysis in 2019 against 2% (p = 0,22) and blood cultures were collected for 4% in 2019 compared to 1% in 2013 (p = 0,14). No early onset neonatal infection was observed. A probabilistic antibiotic therapy was administered to 4% of newborns in 2019 compared to 1% in 2013 (p = 0,14). The mean duration of therapy was no different (p = 0,12). Every newborn with antibiotics received amoxicillin and gentamicin in 2019 and 50% received cefotaxime and gentamicin in 2013 (p < 0,05). The average length of stay is significantly different if a newborn receives antibiotic therapy or not (p = 0,01). Conclusion: The study showed that the guidelines are followed by professionals with the exception of administrations of antibiotic therapy per and postpartum. The recommendations of 2019 are less invasive in view of the decrease in the number of peripheral samples, and in view of the decrease in administration of triple combinations of antibiotics. The administration of probabilistic neonatal antibiotic therapy is associated with an increase in the length of stay.
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https://dumas.ccsd.cnrs.fr/dumas-03238223
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Submitted on : Thursday, May 27, 2021 - 7:02:32 AM
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Bertille Rouxel. Évaluation des pratiques professionnelles sur les recommandations concernant l’infection néonatale bactérienne précoce et leurs conséquences chez les nouveau-nés. Gynécologie et obstétrique. 2020. ⟨dumas-03238223⟩

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