NATIONAL guideline changes in France reduced nonsevere early onset neonatal bacterial infection hospitalizations without increasing severe cases.
In 2017, French early onset neonatal bacterial infection guidelines replaced systematic microbiological sampling of asymptomatic at-risk newborns with structured clinical surveillance. Clinicians feared that fewer cultures might delay or miss diagnoses, potentially increasing severe infections or late onset disease. This nationwide retrospective cohort study evaluated whether early onset neonatal bacterial infection management guidelines altered hospital admissions and costs at the population level.
Guideline Impact on Early Onset Neonatal Bacterial Infection
Using the French National Hospital Discharge Database, investigators examined newborns of at least 34 weeks’ gestational age hospitalized with a neonatal bacterial infection during the first 28 days of life between 2014 and 2023. Monthly incidence rates per 1000 live births were modeled with segmented regression to compare trends before and after guideline implementation in 2017.
For nonsevere early onset neonatal bacterial infection, the expected hospitalization rate at the start of the postguideline period was 9.13 per 1000 live births, compared with an observed rate of 6.17 per 1,000, a relative reduction of approximately one third. A similar reduction, close to 30 percent, was seen for early onset infections not requiring neonatal intensive care unit admission. In contrast, there were no significant changes in rates of severe early onset infection, early onset infection requiring neonatal intensive care unit admission, or late onset neonatal bacterial infection across the study period.
Clinical And Economic Implications for Newborn Care
The stability of severe early onset disease and late onset neonatal bacterial infection suggests that clinical surveillance of asymptomatic newborns can safely replace routine systematic sampling in this context. Importantly, between 2014 and 2023, the total cost of early onset neonatal bacterial infection hospitalizations fell from just under 46 million euros to about 23 million euros, representing a reduction of around 50 percent.
For U.S. clinicians, these findings support careful risk based monitoring and targeted investigations for early onset neonatal bacterial infection, while underscoring the importance of maintaining robust systems for rapid recognition of infants who do deteriorate. The French experience suggests that thoughtfully implemented guidelines can reduce low acuity neonatal bacterial infection admissions and associated costs without compromising safety.
Reference: Paucard L et al. Hospital admissions after early onset neonatal bacterial infection management guidelines in France. JAMA Netw Open. 2025;8(11):e2545436.
