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Sikias P, Biran V, Foix-L'Hélias L, Plainvert C, Boileau P, Bonacorsi S. Early-onset neonatal sepsis in the Paris area: a population-based surveillance study from 2019 to 2021. Arch Dis Child Fetal Neonatal Ed 2023; 108:114-120. [PMID: 35902218 PMCID: PMC9985718 DOI: 10.1136/archdischild-2022-324080] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Early-onset neonatal sepsis (EOS) is a rare condition but an important cause of severe morbidity and mortality in neonates. METHODS This 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). RESULTS 108 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). CONCLUSION In 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.
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Affiliation(s)
- Paola Sikias
- Hôpital Privé d' Antony, Ramsay Santé, Antony, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,FHU I2D2, UMR 1131, INSERM, Paris, France
| | - Laurence Foix-L'Hélias
- Department of Neonatology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Sorbonne University, Paris, France
| | - Céline Plainvert
- Service de Bactériologie ; Centre National de Référence des Streptocoques, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Paris, France.,Université de Paris, Paris, France
| | - Pascal Boileau
- Department of Neonatal Pediatrics, Poissy Saint-Germain Hospital, Versailles Saint-Quentin en Yvelines University, Poissy, France.,UFR des sciences de la santé Simone Veil, Versailles Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Stéphane Bonacorsi
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, CNR Escherichia coli, Paris, France.,Université de Paris, IAME, INSERM, Université Paris Diderot, Paris, France
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Fouminet M, Barrois S, Derredinger I, Baraton L, Roze JC, Boscher C, Leguen CG, Muller JB. Identification of newborns at risk of early-onset neonatal infection: New French guidelines and practices at Nantes University Hospital. Arch Pediatr 2023; 30:71-73. [PMID: 36462991 DOI: 10.1016/j.arcped.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 08/24/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
New French guidelines in 2017 aimed to improve the identification of newborns at risk of early-onset neonatal infection (EONI). Identification is based on perinatal risk factors, management of perinatal antibiotic prophylaxis, and standardized clinical assessment. We conducted a retrospective cross-study at the University Hospital of Nantes. The main objective was to assess implementation of the French guidelines. Of 1240 births included, 40% (501) required perinatal antibiotic prophylaxis (adequate in 67.3%) and 306 (24.7%) needed a standardized clinical assessment (performed in 69.2%). Only two newborns (0.16%) included in the study received neonatal antibiotic therapy. On the basis of the assessment conducted in our maternity ward, implementation of the recommendations seems to be effective.
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Affiliation(s)
- M Fouminet
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - S Barrois
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - I Derredinger
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - L Baraton
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France; Clinical Epidemiology, Clinical Investigation Center (CIC004), University Hospital Centre Nantes, France
| | - J C Roze
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France; Clinical Epidemiology, Clinical Investigation Center (CIC004), University Hospital Centre Nantes, France
| | - C Boscher
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France; Clinical Epidemiology, Clinical Investigation Center (CIC004), University Hospital Centre Nantes, France
| | - C Gras Leguen
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France
| | - J B Muller
- Pediatric and Neonatal Intensive Care Unit, Nantes University Hospital, 38 bld Jean Monnet, Nantes 44000, France; Clinical Epidemiology, Clinical Investigation Center (CIC004), University Hospital Centre Nantes, France.
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Schmitt C, Novy M, Hascoët JM. Term newborns at risk for early-onset neonatal sepsis: Clinical surveillance versus systematic paraclinical test. Arch Pediatr 2021; 28:117-122. [PMID: 33446431 DOI: 10.1016/j.arcped.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/06/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Early-onset neonatal sepsis is a rare but potentially lethal infection that is very often suspected in daily practice. Previous national guidelines recommended the use of systematic paraclinical tests for healthy term newborns with suspected infection. These guidelines were updated in 2017 by the French Health Authority (Haute Autorité de santé), and promote initial clinical monitoring taking into account the infectious risk level for term and near-term born infants. OBJECTIVES To assess the impact of the new recommendations on antibiotic therapy prescription and invasive tests, and on the outcomes of infants born from 36weeks' gestation. MATERIALS AND METHODS This study compared the management and the outcome of neonates born from 36weeks' gestation at the level III University Hospital of Nancy, according to their infectious risk level during two periods, before and after the update of national recommendations: from July 1 to December 31, 2017, versus July 1 to December 31, 2018. Data were retrospectively collected from the infants' files. This study compared the number and length of antibiotic treatment and the number of invasive tests, the number of documented infections, the number and length of hospitalization, and mortality between the two periods. RESULTS During the first period, among 1248 eligible newborns, 643 presented an infectious risk factor, versus 1152 newborns with 343 having an infectious risk factor during the second period. Antibiotic treatment was initiated for 18 newborns during the first period (1.4%) and for nine during the second (0.8%) (P=0.13). The mean (SD) duration of the antibiotic treatment was longer in the first than in the second period: 6.3±2days vs. 3.1±2.3days (P=0.003). There was no death related to neonatal infection. A total of 1052 blood samples were collected during the first period versus 51 during the second (P<0.01). There was no documented infection. In the first period, there were 18 newborns (1.4%) hospitalized for suspected infection versus nine (0.8%) in the second period (P=0.13). The duration of hospitalization was 5.7±1.7days in the first period versus 5.2±3days in the second (P=0.33). CONCLUSION In this study, the application of the new guidelines enabled a reduction of antibiotic exposure and a reduction of invasive tests without additional risk.
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Affiliation(s)
- C Schmitt
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France.
| | - M Novy
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France
| | - J-M Hascoët
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France; DevAH, Lorraine University, 54000 Nancy, France
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Cabaret B, Latry V. 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. Arch Pediatr 2021; 28:159-165. [PMID: 33446432 DOI: 10.1016/j.arcped.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/30/2020] [Accepted: 12/06/2020] [Indexed: 11/28/2022]
Abstract
The 2017 Haute Autorité de santé (HAS) guidelines for the medical care of neonates born at≥34 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.
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Affiliation(s)
- B Cabaret
- Pediatric department, CH de Bigorre, boulevard de Lattre-de-Tassigny, 65000 Tarbes, France.
| | - V Latry
- Research department, CH de Bigorre, boulevard de Lattre-de-Tassigny, 65000 Tarbes, France
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Dain C, Rozé JC, Caillon J, Flamant C, Muller JB, Boscher C, Launay E, Gras-Le Guen C. Epidemiology of invasive early-onset neonatal infection in a French administrative district: A 10-year population-based study. Arch Pediatr 2020; 27:356-361. [PMID: 32896455 DOI: 10.1016/j.arcped.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/26/2020] [Accepted: 07/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND In light of the pending update of the French guidelines for the management of neonatal infections, knowing the current epidemiology of early-onset neonatal infection (EONI) is essential. OBJECTIVES The aim of this study was to assess the current epidemiology of a French administrative district population of proven EONI, including umbilical cord blood procalcitonin levels. METHODS We conducted a retrospective population-based study in the Nantes metropolitan area. We included all infants treated for proven EONI in the maternity, neonatology, and intensive care wards between 1 January 2006 and 31 December 2015 in the Nantes University Hospital. RESULTS Among the 140,502 children born during the study period, 61 cases of EONI were documented. The overall incidence of confirmed EONI was 0.43/1000 live births, with 0.23/1000 GBS (group B streptococcus) infections and 0.08/1000 Escherichia coli infections. The majority of infected newborns were full-term or late-preterm infants (67% were≥34 weeks of gestation), 88% had symptoms of EONI in the first 24h of life, most of which were respiratory. The mortality rate was 8% (in premature infants). Available in 51% of the population, the cord blood PCT value could contribute to an earlier diagnostic screening in 10% of cases but with a very low sensitivity. CONCLUSIONS The incidence of confirmed EONI is low in this French district. The diagnostic value of PCT umbilical blood cord should be assessed based on further studies before confirming its value. We suggest that a national registry of these rare but serious cases of EONI could contribute to monitoring the epidemiological progression as well as to optimizing our diagnostic and therapeutic strategies.
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Affiliation(s)
- C Dain
- Department of perinatal medicine, Nantes University Hospital, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
| | - J-C Rozé
- Department of perinatal medicine, Nantes University Hospital, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - J Caillon
- Department of bacteriology, Nantes University Hospital, 8, boulevard Moncousu, 44093 Nantes cedex 1, France
| | - C Flamant
- Department of perinatal medicine, Nantes University Hospital, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - J-B Muller
- Department of perinatal medicine, Nantes University Hospital, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - C Boscher
- Department of perinatal medicine, Nantes University Hospital, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - E Launay
- Department of pediatry, Nantes University Hospital, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
| | - C Gras-Le Guen
- Department of pediatry, Nantes University Hospital, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France.
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Huetz N, Launay E, Gascoin G, Leboucher B, Savagner C, Muller JB, Denizot S, Boscher C, Caillon J, Masson D, Gras Le Guen C. Potential Impact of Umbilical-Cord-Blood Procalcitonin-Based Algorithm on Antibiotics Exposure in Neonates With Suspected Early-Onset Sepsis. Front Pediatr 2020; 8:127. [PMID: 32363168 PMCID: PMC7181674 DOI: 10.3389/fped.2020.00127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/09/2020] [Indexed: 01/05/2023] Open
Abstract
Context: The incidence of early-onset neonatal infection has greatly decreased, but a new diagnostic approach is needed to avoid overdiagnosis and overtreatment. The aim of this study was to assess the potential impact of an algorithm incorporating umbilical-cord-blood procalcitonin (PCT) level on neonatal antibiotics prescription rate as compared with current practice. Material and methods: We conducted a prospective study in three maternity wards in France. All term and preterm neonates with the usual risk factors for neonatal group B Streptococcus infection were eligible for umbilical-cord-blood PCT testing. We compared the proportion of neonates who were exposed early to antibiotics (before 6 days of life) to that of neonates for whom antibiotics prescription would be indicated according to the PCT-based algorithm. Results: Among the 3,080 neonates included, 1 neonate presented with certain infection and 38 neonates with probable infection. The global antibiotics prescription rate was 4.6% [95% confidence interval (CI), 4.1-5]. With the PCT-based algorithm, the potential decrease in prescription rate would be 1.8% (95% CI, 1.3-2.3), corresponding to a 39% (95% CI, 37.3-40.7) relative reduction in antibiotics exposure (p < 0.05). Conclusion: These results suggest that the umbilical-cord-blood PCT-based algorithm could significantly help the clinicians in their antibiotic prescription decision to decrease neonatal antibiotics exposure as compared with current practice. If validated in a larger interventional randomized study, this approach could help clinicians stratify the risk of early-onset neonatal infection and initiate early antibiotics treatment in newborns at high risk of infection while limiting the deleterious effects of useless prescriptions in non-infected newborns.
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Affiliation(s)
- Noémie Huetz
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Elise Launay
- Clinical Investigation Center 004, INSERM 1413, Nantes University Hospital, Nantes, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France.,Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | - Bertrand Leboucher
- Department of Neonatal Medicine, Angers University Hospital, Angers, France.,Loire Infant Follow-Up Team (LIFT) Network, Pays de Loire, France
| | | | - Jean B Muller
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Sophie Denizot
- Department of Neonatology, Polyclinique de l'Atlantique, St Herblain, France
| | - Cécile Boscher
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Jocelyne Caillon
- Laboratory of Microbiology, Nantes University Hospital, Nantes, France
| | - Damien Masson
- Laboratory of Biochemistry, Nantes University Hospital, Nantes, France
| | - Christèle Gras Le Guen
- Clinical Investigation Center 004, INSERM 1413, Nantes University Hospital, Nantes, France
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Frerot A, Baud O, Colella M, Taibi L, Bonacorsi S, Alberti C, Mohamed D, Biran V. Cord blood procalcitonin level and early-onset sepsis in extremely preterm infants. Eur J Clin Microbiol Infect Dis 2019; 38:1651-1657. [PMID: 31154524 DOI: 10.1007/s10096-019-03593-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/14/2019] [Indexed: 12/15/2022]
Abstract
Early-onset neonatal sepsis (EOS) is observed in 1.7% of extremely preterm infants, with high morbidity and mortality rate. Cord blood procalcitonin (PCT) is a sensitive marker of EOS in full-term newborns, but it has been rarely studied in premature infants. The diagnostic value of cord blood PCT by immunofluorescence has been assessed as an early marker of EOS in a prospective cohort of extremely preterm infants, with a threshold at 0.5 μg/L. EOS was defined by a positive bacterial culture or by the association of postnatal biological/clinical signs of EOS and antibiotic treatment for more than 72 h. Correlation between PCT serum concentrations and postnatal morbidities was also analyzed. Among a total of 186 infants, 45 (24%) were classified as EOS. Blood PCT concentration was ≤ 0.5 μg/L in 114 infants, including 11 EOS (9.6%) and PCT was > 0.5 μg/L in 72 babies including 34 EOS (47.2%). PCT concentration > 0.5 μg/L was associated with higher risk of EOS (OR 2.18; CI95% 1.58-3.02; p < 0.0001). The receiver operating characteristic curve determined a cutoff of 0.7 μg/L as the best compromise, with an area under the curve of 0.75 (sensitivity 69%, specificity 70%). In multivariate analysis, clinical chorioamnionitis was associated with PCT concentration > 0.5 μg/L (OR 2.58; CI95% 1.35-4.94; p = 0.004). Cord blood PCT is a marker significantly associated with EOS in extremely preterm infants, but its sensitivity remains low. Its added value in combination with other early marker of EOS needs to be further investigated in this high-risk population.
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Affiliation(s)
- Alice Frerot
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France
- PROTECT, Inserm 1141, Université Paris Diderot, Sorbonne Paris Cité, 75019, Paris, France
- PremUP Foundation, 75014, Paris, France
| | - Olivier Baud
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France
- PROTECT, Inserm 1141, Université Paris Diderot, Sorbonne Paris Cité, 75019, Paris, France
- PremUP Foundation, 75014, Paris, France
- Division of Neonatology and Pediatric Intensive Care, Children's University Hospital and University of Geneva, Geneva, Switzerland
| | - Marina Colella
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France
- PROTECT, Inserm 1141, Université Paris Diderot, Sorbonne Paris Cité, 75019, Paris, France
- PremUP Foundation, 75014, Paris, France
| | - Ludmia Taibi
- Biochemistry Department, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France
| | - Stéphane Bonacorsi
- Microbiology Department, Assistance Publique-Hôpitaux de Paris, Robert Debré Children' Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France
| | - Corinne Alberti
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's hospital, Inserm U1123 and CIC-EC 1426, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France
| | - Damir Mohamed
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's hospital, Inserm U1123 and CIC-EC 1426, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert Debré Children's Hospital, University Paris Diderot, Sorbonne Paris-Cité, 75019, Paris, France.
- PROTECT, Inserm 1141, Université Paris Diderot, Sorbonne Paris Cité, 75019, Paris, France.
- PremUP Foundation, 75014, Paris, France.
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Aires J. Microbiote intestinal du nouveau-né : impact des antibiotiques. Arch Pediatr 2017; 24 Suppl 3:S1-S4. [DOI: 10.1016/s0929-693x(18)30036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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