Longitudinal growth of French singleton children born after in vitro fertilization and intracytoplasmic sperm injection. Body mass index up to 5 years of age.

BACKGROUND: The literature presents conflicting results on the epigenetic effect of in vitro fertilization (IVF) on the short-term and mid-term growth of children. These contradictory results may be related to the use of heterogeneous methodologies and non-longitudinal data. The goal of this study was to compare the body mass index (BMI) of children conceived via IVF and spontaneous conception (SC) children, using longitudinal data from birth to 5 years. METHODS: This study compared 118 singleton children born after in vitro fertilization, with or without intracytoplasmic sperm injection (ICSI), selected from a pre-existing single-center cohort to 320 SC children from the same geographic area. BMI and its evolution were analyzed using the mixed-effect model during three periods: before standing acquisition (from birth to 1 year of age), during standing acquisition, and the following period from 2 to 5 years of age. RESULTS: BMI means were not significantly different between groups regardless of the period, when adjusting for confounding factors related to parents, pregnancy, and children's characteristics and lifestyle. Nevertheless, during the standing acquisition period, children born after IVF-ICSI presented a less significant decrease in BMI (P<0.05). In addition, for each period we identified influencing factors (maternal BMI, level of wealth indicator) associated with BMI. CONCLUSION: In the study population, the suspected epigenetic influence of IVF reported in the literature was not observed for BMI from birth to 5 years of age. Further investigations need to be conducted to determine if the suspected influence of IVF on adiposity could be expressed through other parameters.

[Evaluation of the action « M'T Dents ¼ for 6-year-old schoolchildren on two deprived neighborhoods in Marseille, France]. / Evaluation de l'action « M'T dents ¼ auprès des enfants de 6 ans scolarisés sur deux quartiers défavorisés à Marseille.

Background: This study aims to analyze the effects of the national program for individual dental prevention "M'T Dents" to 6-years-old children living in the neighborhoods of deprived areas Saint-Mauront and Belle de Mai from 2009 to 2012 (Marseille, France). These children having received an additional collective awareness and individual monitoring as part of the experimental program of health promotion "La Santé à Saint Mauront - Belle de Mai: on s'y met tous!" led by the PACA Regional Health Agency. Materials and Methods: Awareness sessions in oral hygiene were led in CP grades of 5 schools and each child was then followed and encouraged to resort to dentist. Data on the use of the bucco-dental examination (BDE), the use of consecutive care and the oral health status of children were collected. Results: Of the three years considered by this study, 56 classes and more than 1000 children were involved by this prevention program. The average use of BDE was 27.70%. Among children who received the BDE, 44.33% required treatment, approximately 26% with 1-3 untreated caries, 12%: 4-6 caries and 6%: 7 caries or more. Nearly 60% were completely cured, 15% partially and 25% not treated within 6 months following the BDE. Care utilization varied by initial caries index: the percentage of children fully treated was significantly higher for children with 1-3 caries than those with 4-6 caries (p <0.05) and those with 7 caries or more (p < 0.001) when the BDE. Conclusion: Modes of action that are reinforced in this territory seem possible to achieve results comparable to those observed in the same age group at the national level for children. More children were able to use the dentist and receive consecutive care under this program contributes to reducing inequalities in oral health.

[Patient education: state of the art of the programs in the region of Provence-Alpes-Côte d'Azur in 2008 before the publication of official documents relative to the authorizations of the Regional Health Agency (ARS)]. / Éducation thérapeutique du patient : état des lieux des programmes en région Provence-Alpes-Côte d'Azur en 2008 avant la parution des textes officiels sur les autorisations de l'Agence Régionale de Santé.

BACKGROUND: At the request of the Hospitalization Regional Agency (ARH)--in the context of the 2007-2011 plan aimed at improving the quality of life for patients affected by chronic diseases--the purpose of this work was to draw up a clear assessment of the 2008 Therapeutic Education programmes in the Provence-Alpes-Côte d'Azur (PACA) region. The study was carried out before the publication of the therapeutic education statutory orders and ARS (regional health agency) authorizations. METHODS: Cross-sectional study, carried out in the three sectors of medical management in the region--namely health-care institutions, ambulatory structures and health networks--made it possible to identify, first, which structures had actually launched therapeutic education programmes and then, how the procedures had been designed and set up. RESULTS: Among all the medical structures investigated, the study has listed 491 programmes, heterogeneously located throughout the PACA region. These programmes primarily target diabetes, respiratory and cardiovascular diseases. Their main objectives are the patients' quality of life, adherence to treatment and protective health behaviour (health improvement). The hospitalization sector programmes preferentially target the 30 to 60 years old, whereas the ambulatory and health networks programmes are more inclined to target the over 60 years old part of the population. More than 50% of the professionals involved in the programmes have never benefited from a specific training concerning the patients' therapeutic education. CONCLUSION: This study has pointed out a great number of important aspects which need drastic improvement in terms of therapeutic education organization - the involvement and training of health professionals, for instance.

[3D conformal radiation therapy and hormonal therapy for localized prostate cancer: is age a limiting factor?]. / La radiothérapie conformationnelle associée à l'hormonothérapie du cancer de prostate localisé: l'âge est-il un facteur limitant ?

No study on side effects had showed that conformal radiation therapy for prostate cancer is more harmful in patients older than 70 years to patients younger. The aim of this study was to evaluate acute and late toxicities of conformal radiotherapy, with high dose for localized prostate cancer in patients older than 70 years and compared to patients younger than 70 years. Between 1996 and 2009, 104 patients were treated with radiation therapy and hormonal therapy for localized cancer prostate. Median follow-up was 105 months (9-300). Acute (occurred at ≤ three months) and late side effects of 55 patients older than 70 years (median age: 75 [71-92]) were graded according to the CTCAE 3.0 criteria and compared to the younger population. Median dose to the prostate was 75.6 Gy (67-80) in both groups. There were no significant differences in acute and late side effects between age groups. For patients above 70 years, the incidence of grade II or higher acute and late side effects were respectively 27 and 22% for urologic symptoms and 13 and 16% for rectal symptoms. The frequency of grade III late symptoms was low and ranged between 0 and 6% for the evaluated symptoms, irrespective of age group. Older patients had a better biochemical recurrence-free survival than younger patients (86 versus 77% at four years, P=ns). High dose 3D conformal radiotherapy for localized prostate cancer was well tolerated in patients older than 70 years. Age is not a limiting factor for conformal radiation therapy and hormonotherapy for older patients.

Descriptive study of young disabled children aged 2-6, enrolled in mainstream schools, and benefiting from special needs assistants in the Bouches-du-Rhône in 2014.

BACKGROUND: Since the law of February 11, 2005, in France, the number of children with disabilities enrolled in ordinary schools has increased steadily. As a result, the amount of personal support provided by a special needs assistant (personal support) is also increasing. The aim of the study was to describe the diseases and impairments of disabled children aged 2-6, enrolled in mainstream schools and benefiting from personal support for schooling by special needs assistants in the Bouches-du-Rhône (France) in 2014. METHODS: A cross-sectional descriptive study was performed. Children included were benefiting from either an individual or shared personal support. Physicians from the territorial organization in charge of disability coded diseases and deficiencies using the International Classification of Diseases, 10th revision, and nomenclature inspired by the International Classification of Functioning, Disability and Health. RESULTS: Medical data were coded for 990 children out of 1260 of the total population. These young disabled children were most frequently children with pervasive developmental disorders (23.3%), lack of expected normal physiological development (19.9%), or mixed specific developmental disorders (13.5%), and most often had behavioral, personality, and relational skills disorders (61.8%), psychomotor function impairments (51.9%), or written or oral language learning impairment (43.2%). Finally, the two main types of impairments most represented among these children were psychological impairments (86.7%) and language and speech impairments (79.8%). The children were most often supported by an individual personal support (for one child only) than by a shared personal support (60% vs. 40%). They were mainly boys (almost 75%). CONCLUSION: This study provides working guidelines for the management of health policies relating to disability at the territorial or even national level.

[Do non-urgent patients presenting to an emergency department agree with a reorientation towards an alternative care department?]. / Les patients "non urgents" se présentant dans les services d'urgence sont-ils favorables à une réorientation vers une structure de soins alternative?

BACKGROUND: Emergency department (ED) utilization has increased for several decades. ED-s are becoming more and more busy because of patients with non-urgent problems, and their demand for service has resulted in overcrowding in ED. To resolve this problem, primary care units involving general practitioners have been established. The objective of this study is to assess provision of the shift to other health care facilities for no urgent ED patients, starting from entry to ED at the request of the triage nurse. METHODS: A cross-sectional study was conducted during a one-week period in the adult ED of La Conception Hospital in Marseilles, France. Only no urgent patients identified prospectively by the triage nurse were included. Information was gathered regarding the usual source of care, reason for the visit, care itinerary before presenting to the ED, patient's perception of emergency level, their willingness regarding a reorientation to another health care facility, accomplished actions, and type of discharge. RESULTS: Among 245 ED patients, 110 were identified as no urgent by the triage nurse, and 85 effectively answered questions for the purpose of this study. In 76.4% of the cases, the patients were self-referred to ED, however one-third had contacted a physician. The most common reasons provided for attending the ED were pain (55.3%), laboratory and radiographic investigations (37.6%), and difficulty in accessing the usual source of care (22.3%). The mean level of emergency perception was 10.6+/-5.6 on a zero-twenty scale. Half of the patients presented for traumatology concerns. One-third had an additional examination, six received treatments, and none were hospitalized. Upon entry to ED, more than two-thirds of patients accepted the principle of reorientation to another health care facility. Two main factors linked with this decision were employment status (odds-ratio [OR]=4.5; 95% confidence interval [CI]=1.6-12.9) and the perceived emergency level (OR=0.88; 95% CI=0.8-0.9). Among patients who refused reorientation, 41 of them were able to pay an additional cost to receive care in the ED. CONCLUSION: Alternative structures such as primary care units near the ED seem to be an appropriate response to meet the growing demand of no urgent patients. The success of providing this reorientation, however, could be determined by the working hours of the structures and the practice of certain technical skills.

[Medical emergency care units in France]. / Les maisons médicales de garde en France.

UNLABELLED: The objective of this article is to take inventory of the different medical emergency care units in France as of June 30, 2003, and to describe their main characteristics. METHODOLOGY: A telephone survey was conducted which posed questions based on a standard questionnaire to the Regional Unions of Liberal Doctors, the County Advisory Boards of the Medical Orders, and the directors and managers of the existing emergency care units. RESULTS: 97 medical safe houses were inventoried, 46 of which were operational and 51 which were in development. The Ile-de-France region is the region with the highest concentration of these units either operating or under construction. A large majority of the emergency care units were created since the year 2000, and half of them are located within health care centres and the other half into separate cells either close or distant from existing health care centres. More than half of them have no other staff aside from doctors, whilst the others comprise a spectrum of personnel including secretaries, nurses, and social assistants amongst others. More than half of the doctors are paid at the cost of each consultation and per treatment and do not have a technical platform at their disposal. Usually, these emergency care units are open all night during the week and on the weekends. One-third of them collaborate with the emergency centre and ambulance service (those who respond to calls to 15) and three-quarters of them are funded by the city's Assistance Fund for the Quality of Care. CONCLUSION: It would seem advantageous that a Charter for operation and management of these establishments be drafted and implemented in order standardise these types of structures and that their supervisors implement a national and regional follow-up mechanism for the establishments in order to better evaluate the evolution in terms of health care organisation, in particular with respect to raising the level and capacity of response.

Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap.

OBJECTIVE: To determine the role of nonmedicated soap as a source of Serratia marcescens nosocomial infections (NIs) in hospital units with endemic S marcescens NI and to examine the mechanisms of soap colonization. SETTING: University-affiliated tertiary-care hospitals. METHODS: A prospective case-control study and an environmental investigation were performed to assess the relationship between S marcescens NIs in hospital units and S marcescens-contaminated soap. Soap-bottle use and handwashing practices were reviewed. Cultures of healthcare workers' (HCWs) hands were obtained before and after hand washing with soap. RESULTS: 5 of 7 hospital units with S marcescens NIs had soap bottles contaminated with S marcescens, compared to 1 of 14 other units (P=.006). After hand washing with an S marcescens-contaminated soap pump, HCWs' hands were 54 times more likely to be contaminated with S marcescens (P<.001). CONCLUSIONS: Extrinsic contamination of a non-medicated liquid soap by S marcescens resulted in handborne transmission of S marcescens NIs by HCWs in our setting. This finding led to the application of strict guidelines for nonmedicated soap use and to the reinforcement of alcoholic hand disinfection.

Evaluation of a disinfection procedure for hysteroscopes contaminated by hepatitis C virus.

We assessed the ability of a standard disinfection procedure to eliminate hepatitis C virus (HCV) from the air-water channel of hysteroscopes. The residual HCV RNA remaining after the disinfection procedure was measured by polymerase chain reaction. When correctly applied to hysteroscopes, the standard disinfection procedure was sufficient to eliminate the risk of HCV transmission.

Season of birth and schizophrenia: sex difference.

1. A statistically significant increased risk of schizophrenia for individuals born in winter has been reported. The increase risk is of the order of 5-15 percent. The seasonal effect is more marked among females. This winter birth effect suggests some environmental agents, probably a neuropathogen one, acting on the foetus. 2. The present study sought to test the environmental damage hypothesis by application of the family history of psychiatric disorder distinction to season of birth data divided according to sex and using a control population. 3. From computer records, all patients admitted to the psychiatric department of Marseilles Timone hospital between January 1984 and December 1989 who satisfied DSM III, DSM III R criteria for schizophrenia were identified. Patients were then classified into two groups: family history of psychiatric disorder versus no family history. Division according to the sex was carried on after two groups were formed. 4. The data show (I) a significant excess of births in the early months of the year (p < 0.05) for all patients with no family history of psychiatric disorder, (2) a significant excess of births for females (p < 0.05) with no family history. 5. These results provide indirect support for the neurodevelopmental theory of schizophrenia.

Prevalence surveys of nosocomial infections using a random sampling method in Marseille hospitals.

In 1992, we conducted two prevalence surveys on hospital-acquired infections (HAIs) in a group of eight university affiliated hospitals with a total of 4462 acute care beds. Most of the intensive care units (ICUs) already had a prospective surveillance scheme. The need for HAI rates that could be estimated easily and economically led us to develop a prevalence survey by using a stratified sampling method. The units were distributed into four groups: ICU; clean surgery; other surgery; and medical. In each group a sample of units was randomly selected using different sampling fractions. The first survey was conducted in May and involved 1220 patients. The second survey in November included 1389 patients. The HAI rates in May and November were 8.6% (95% CI 7.4-9.8%) and 7.1% (95% CI 6-8.2%), respectively. This study allowed us to direct resources towards high risk units and clean surgical procedures. Based on the results, prospective surveillance was implemented in units of the clean surgery group.

[Effects of a subanaesthetic dose of ketamine on emotional and behavioral state in healthy subjects]. / Evaluation psychocomportementale de l'administration de faible dose de kétamine chez le sujet sain.

Schizophrenic patients suffer from positive (delusions, hallucinations) and negative signs (social withdrawal) as well as emotional disturbance that included quantitative (blunted affect) and qualitative impairments (discordance of emotional level). Ketamine, a phencyclidine derivative, is a non competitive N-methyl-D-aspartate (NMDA) glutamate receptor antagonist. In healthy subjects its administration induces some positive symptoms (perceptual distortions.), negative symptoms (emotional deficit, apathy, social withdrawal) and cognitive changes (memory impairments and perseverations) that resemble some aspects of the symptoms of schizophrenia. A double blind cross over, placebo controlled was performed in 12 normal subjects with 2 sessions separated by one week of wash-out to determine ketamine-induced effects on behavioral and emotional responses. During each session, subjects received either ketamine or placebo (saline) infusion. A subanesthetic dose of ketamine (0,5 mg/kg) was administered by constant perfusion over 60 min. Behavioral and cognitive responses were assessed using positive and negative symptoms scales (BPRS, items from SAPS and SANS), vigilance and mood visual analog scale, subjective feelings using the Addiction Research Center Inventory (ARCI) and the Profile of Mood States (POMS). Using Philippot's method, emotions were elicited by films segments which induce a diversity of predictable emotions (fear, anger, sadness, joy, disgust and neutral state) and emotional responses were assessed by the Differential Emotions Scale (DES Izard). Low dose of ketamine induced significant effects on 7-items BPRS score (positive and negative items) and significant effects on positive and negative symptoms from SANS and SAPS. This was associated with emotional blunting of visually-induced responses that resemble aspects of schizophrenic emotional impairments. Ketamine impaired ARCI subscales (benzedrine subscale, pentobarbital-chlorpromazine subscale and LSD subscale). The recent findings of ketamine's pharmacology and imaging studies allow to draw several hypothesis related to neurotransmitter systems (glutamate, dopamine, serotonin interactions) and cerebral areas (particularly prefrontal cortex, anterior cingulate cortex, hippocampus) underlying some of these ketamine-induced effects.

[The significance of quantified EEG in Alzheimer's disease. Changes induced by piracetam]. / Intérêt de l'EEG quantifié dans la maladie d'Alzheimer. Modifications induites par le piracétam.

One study was performed in 12 patients with presenile Alzheimer's disease (group I), the other one in 16 patients with mild senile dementia of Alzheimer type (group II). In each study, patients were divided into two randomized parallel groups, one receiving placebo, the other piracetam (9 g daily in group I piracetam and 2.4 g daily in group II piracetam) during three months, piracetam induced a decrease in EEG power on the 2-6 Hz range (group I piracetam), 3-5 Hz and 7 Hz (group II piracetam) and an increase of EEG power in the 9-11 Hz range (group I piracetam) and in the 10 Hz and 13 Hz frequencies (group II piracetam). There was also a significant improvement in the Trail Making Test part A in group II piracetam. Correlations between decreased EEG low frequency components and improvement in some psychometric tests were found significant in the two groups. It seems that the main effect of piracetam was to induce increased alertness. The same results were found in both studies; the good reproducibility suggests that EEG spectral analysis is a reliable tool in the assessment of psychotropic drug effects.

Effect of heavy smoking on nasal resistance.

Smoking is a part of our sociocultural environment. Its medical consequences are probably still underestimated. In this prospective clinical study, we explored the relationship between heavy smoking and nasal resistance. Anterior rhinomanometry was performed in 26 smokers and 26 non-smokers. Each group contained 13 men and 13 women. Analysis of variance of nasal resistance measurements using age and weight as covariables showed no significant difference between sexes. In contrast, a highly significant increase was noted between smokers and non-smokers. Age and weight had no influence on these results. Rhinomanometry proved to be an excellent method of detection for these modifications. Similar studies on the effects of passive smoking and of atmospheric and occupational pollutants should follow in the near future.

[Medico-economic aspects of the treatment of duodenal ulcer: from antisecretory treatment to eradication of Helicobacter pylori]. / Aspects médico-économiques du traitement de l'ulcère duodénal: du traitement antisécrétoire à l'éradication d'Helicobacter pylori.

OBJECTIVES: Radical changes are currently taking place in the treatment of duodenal ulcer, where strategies of eradication of Helicobacter pylori are replacing traditional antisecretory treatment. The aim of this study is to present the economic aspects of the different therapeutic approaches. METHODS: A critical analysis based on a selected number of clinical trials and medical economic analyses published in the international literature. RESULTS: A comparative analysis of traditional ranitidine/omeprazole treatments shows that ranitidine is more cost-effective in France at short term. With regard to traditional strategies, there are no French studies comparing H2-antagonists to proton pump inhibitors. Comparative studies seem in favour of eradication of Helicobacter pylori over traditional therapies, both in terms of cost and effectiveness. CONCLUSION: Arguments comparing the effectiveness of proton pump inhibitors versus H2-antagonists have become obsolete. In current therapeutic approaches of duodenal ulcer, the level of inhibition of the acid secretion no longer plays an important role.

[Anonymity in epidemiological surveys: study and initiation of a new method]. / L'anonymat dans les enquêtes épidémiologiques: étude et mise en oeuvre d'une nouvelle méthode.

The authors propose a system of registering epidemiological data which ensures strict observation of anonymity. Data are made anonymous at the source: the practitioners who possess the medically confidential information themselves compute the code number creating anonymity through a nonreversible calculation formula: it is impossible to work back from the number to the patient's identity, even if one has the formula and powerful computer resources. This method differs from simple data encoding whose key could either be discovered or revealed: it requires neither keys nor a secret but effects a definitive and irreversible transformation. In compliance with the recommendations of the committee on Ethics, of the French "Ordre des Médecins" and of the Law on Data Processing and Liberties, the method was subjected to a double test for reliability, experimental and theoretical.

[Epileptic crisis during and after cerebrovascular diseases. A clinical analysis of 78 cases]. / Les crises épileptiques au cours et au décours des accidents cérébrovasculaires. Analyse clinique de 78 cas.

Seventy-eight patients with post-stroke seizures were studied retrospectively to determine the clinical, EEG and CT features of these seizures and their prognosis. There were 57 cerebral infarctions and 21 hemorrhages. Twenty-eight (36%) initial seizures occurred within one month after the stroke (0-24 hours in 19 cases) and were classified as early-onset seizures. Fifty (64%) initial seizures occurred more than 3 months after the stroke (3-12 months in 33 cases) and were classified as late-onset seizures. Compared with a population of 1938 strokes admitted during the same period, the proportion of patients with alcohol abuse, infarction in the anterior cerebral artery territory, watershed infarcts and lobar haemorrhages was significantly greater in our series. The proportion did not vary with the nature of the stroke (infarction or hemorrhage), except for early onset seizures in which the proportion of hemorrhages was significantly greater. Nor did it vary with the cause of hemispheric infarctions (cardioembolism or atherothrombosis or others). Ninety-five percent of the lesions affected the cerebral cortex or the subcortical white matter or both. Of all 78 initial seizures, 64% were partial motor (simple or secondarily generalized); 32% were primarily generalized, and 4% were partial not motor; status epilepticus was seen in 14% of the cases. An initial EEG, performed in 76 patients was normal in 7. Among the remaining 69 patients EEG showed focal or diffuse slowing down in 63% and epileptic features in 37% (including 10 cases of PLEDs). Early post-seizure EEG and repeated recordings significantly increased the specificity of EEG.(ABSTRACT TRUNCATED AT 250 WORDS)

[Reaction surveillance: organization in public care/hospitals in Marseille]. / Réactovigilance: quelle organisation à l'Assistance publique-Hôpitaux de Marseille ?

For the French Drug Agency (AFSSAPS), the aim of the reactovigilance is to monitor the adverse effects resulting from the use of IVD-MD. More precisely, the goal is to evaluate all incidents and risks that can result in inadequate results or negative effects to the user and therefore for the patient. According to the French Law and before the transposition in the French Law of the European Guideline 98/79/CE, the University Hospital of Marseille has decided to organize its own reactovigilance network. Since 2001, an institutional organization has been set up. For each of the 33 labs of the University hospital one reactovigilant has been nominated as well as one coordinating reactovigilant. Specialized structures have been created: one central committee and one experts group. Standardized operating procedures have been established. The reactovigilance system is also integrated to the vigilance coordination network of the Marseille University Hospital. This organization allows to achieve tracability of all alerts, as well as information and training for the professionals. Four missions are defined: collection and management of all incidents IVD-MD-related; diffusion of AFFSAPS and industrials alerts to all labs in order to take appropriate measures; Tracability of alerts and incidents in all labs and in central committee, tracability of reactives according to French guidelines (GBEA). For the first 10 months of 2002, 46 alerts have been forwarded to all lab's correspondants. In the same period, one real adverse event has been locally notified and after analyse will be forwarded to the AFSSAPS. All these factors should contribute to the health professionals interest and participation in reactovigilance activities.

[Evaluation of cost of laparoscopic surgery in gynecology]. / Evaluation du coût de la chirurgie coelioscopique en gynécologie.

The objective of this work was to evaluate hospital and postoperative costs associated with gynecologic laparoscopic surgery for benign pathologies. Hospital costs were broken down into several categories: operating room, postoperative hospitalization, pharmacy, surgical instruments, sterilization of reused equipment, food and laundry, indirect costs. The mean total costs for the hospitalization time were 8547,2 francs. Medical charges in recovery time were calculated with the help of the Social Security. These charges represented less than 5% of the total cost associated with the procedure.

[Validation trial of a neonatal prophylactic antibiotic protocol in the delivery room]. / Essai de validation d'un protocole d'antibioprophylaxie néonatale en salle de travail.

Maternofetal infection occurs in 1 to 10 of every 1,000 newborns. Prognosis is poor and an extremely rapid the clinical course is sometimes observed. The situation suggests that widespread use of antibiotics and more than 90% of the newborns receiving antibiotics are not infected. A prospective study based on simple, recognized criteria predictive of maternal-fetal infection was conducted in 3,392 deliveries to evaluate the effect of an antibiotic prophylaxy protocol. Specificity, sensitivity, positive and negative predictive value were evaluated for each of the eleven criteria retained with the goal of increasing sensitivity and decrease the use of unnecessary antibiotics. Among the 3,392 infants delivered from January 1989 to December 1990, 286 (8.4%) newborns entered the study and were given mezlocillin (150 mg/kg/12 h). This treatment was stopped at 48 hours of life if the infant was not infected. RESULTS. Infection was confirmed in 48 of 3,392 infants (1.4%). All were in the risk group: 48/286 (16.7%). The germs the most often found were group B Streptococcus (n = 16), Escherichia coli (n = 8) and Listeria monocytogenes (n = 3). Nine criteria were well correlated with maternal-fetal infection. The two most important criteria were maternal pyrexia above 39 degrees C and Apgar score below 7 to 5 min (poor neonatal adaptation), with a 99% and 90% and a positive predictive value of 80% and 37% respectively. Inversely, Two criteria were poorly correlated with maternal-fetal infection: labour duration above 12 hours and instrumental extraction (positive predictive value from 10% to 17%).(ABSTRACT TRUNCATED AT 250 WORDS)