Neonatal early-onset sepsis (EOS) caused by bacteria is a public health concern. Although infectious risk situations are frequent, proven EOS is rare, estimated at 0.5–1 cases per 1000 live births in France [1]. Its difficult clinical diagnosis and severity, and its high mortality rate (12 %), mean that many newborns are given antibiotics without evidence of infection [2]. It is estimated that 7.9 % of full-term live births are treated for suspected EOS each year in Europe [3]. Identifying newborns most at risk of sepsis is essential, and correctly diagnosing the infection at an early stage and treating it remain a challenge. To help French practitioners, the French public health authority HAS updated its guidelines in 2017. Their aim was to harmonize practices, help healthcare professionals identify newborns at risk of infection, and guide them in their management, while curbing the use of antibiotics. The initiation of antibiotic therapy now relies solely on clinical monitoring [4]. Previous guidelines published in 2002 by the French health accreditation body ANAES relied on systematic biological tests in asymptomatic newborns at risk of sepsis [5].

From now on, the new practices classify newborns into three groups of increasing risk (A, B, C) according to ante- and intrapartum risk factors: maternal group B streptococcal (GBS) colonization, prolonged rupture of amniotic membranes lasting more than 12 h, maternal fever, spontaneous preterm births (<37 WG), and intrapartum antibiotic therapy. Clinical monitoring is then tailored to the risk group. Temperature, heart rate, respiratory rate, chest indrawing, grunting, and skin color are used as clinical variables. This change in practice made clinicians uneasy. Some feared they might miss an infection if antibiotic treatment was justified by clinical criteria alone.

The main objective of this study was to determine the impact of these new guidelines on the prescription of antibiotics in terms of initiation and duration. Its secondary objective was to determine whether EOS could be reliably identified.