title: [Diagnostic value of suspicion criteria for early-onset neonatal bacterial infection: report ten years after the Anaes recommendations].
abstract: BACKGROUND
  Because clinical symptoms and biological markers are neither sensitive nor specific, newborns are frequently suspected of having an infection. In France, 30-50% of newborns are suspected of having early-onset sepsis (EOS) and many of them undergo laboratory tests and empirical antibiotic treatments while awaiting results. The aim of this study was to evaluate the diagnostic value of various suspicion criteria for EOS as recommended by the Anaes since 2002, and the value of umbilical cord blood procalcitonin (PCT), currently assayed in our maternity ward.
  
  
  METHODS
  This 4-year retrospective study in the CHU of Nantes included hospitalized newborns with suspected early neonatal infection. Infection status was established according to the Anaes definitions and clinical evolution.
  
  
  RESULTS
  The study included 2151 newborns. Among anamnestic criteria, only prematurity significantly increased the risk of EOS (relative risk of 3.1; 95% CI 1.4-7.0). The relative risk of infection for a symptomatic newborn was 12.2 (95% CI 4.9-30.2; P<0.0001). Laboratory test results were the most predictive criteria. The relative risk to be infected was 291.6 (95% CI 70.7-1,214.0; P<0.0001) with a blood cord PCT value>0.6 ng/L. The positive post-test probability was 28% (95% CI: 23-33) and the negative post-test probability was close to 0 (95% CI: 0-0).
  
  
  CONCLUSIONS
  Clinical criteria of postnatal life adaptation are more predictive of early-onset neonatal infection than anamnestic criteria are. The blood cord PCT value could be a helpful marker in the identification of infected newborns. PCT measured in umbilical cord blood could be included in a general algorithm in order to identify as soon as possible newborns with a high risk of EOS.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Cottineau
authors.affiliation: Service de pédiatrie, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Launay
authors.affiliation: Réseau de santé en périnatalité « sécurité naissance-naitre ensemble » des pays de Loire, 2, rue de la Loire, 44200 Nantes, France.
authors.forename: B
authors.initials: B
authors.lastname: Branger
authors.affiliation: Laboratoire UPRES EA 3826, faculté de médecine, université de Nantes, 44000 Nantes, France.
authors.forename: J
authors.initials: J
authors.lastname: Caillon
authors.affiliation: Service de néonatologie, hôpital Mère-Enfant, CHU de Nantes, boulevard Jean-Monnet, 44093 Nantes cedex, France.
authors.forename: J-B
authors.initials: JB
authors.lastname: Muller
authors.affiliation: Service de néonatologie, hôpital Mère-Enfant, CHU de Nantes, boulevard Jean-Monnet, 44093 Nantes cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Boscher
authors.affiliation: Service de gynécologie-obstétrique, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Laurens
authors.affiliation: Service de pédiatrie, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Cabaret
authors.affiliation: Service de néonatologie, hôpital Mère-Enfant, CHU de Nantes, boulevard Jean-Monnet, 44093 Nantes cedex, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Roze
authors.affiliation: Service de pédiatrie, hôpital Mère-Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex, France; Laboratoire UPRES EA 3826, faculté de médecine, université de Nantes, 44000 Nantes, France; Service de néonatologie, hôpital Mère-Enfant, CHU de Nantes, boulevard Jean-Monnet, 44093 Nantes cedex, France. Electronic address: christele.grasleguen@chu-nantes.fr.
authors.forename: C
authors.initials: C
authors.lastname: Gras-Le Guen
mesh_terms: D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D019348:Empiricism; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005602:France; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011336:Probability; D011498:Protein Precursors / Q000097:blood; D012189:Retrospective Studies; D012306:Risk; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide