Neonatal outcomes following previable prelabour rupture of membranes before 23 weeks of gestation - A retrospective cohort study

Article type: Research Article

Authors: Pendse, A.^{a; b; *} | Panchal, H.^{a; b; d} | Athalye-Jape, G.^{a; b; c; d} | Campbell, C.^{a; g} | Nathan, E.^{e; f} | Rao, S.^{b; c; d} | Dickinson, J.E.^{e; f; h}

Affiliations: [a] Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Australia | [b] Neonatal Directorate, Perth Children’s Hospital, Perth, Australia | [c] School of Paediatrics, University of Western Australia, Perth, Australia | [d] Centre for Neonatal Research and Education, University of Western, Australia, Perth, Australia | [e] Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia | [f] Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia | [g] Department of Psychological Medicine, King Edward Memorial Hospital for Children, Perth, Australia | [h] Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Perth, Australia

Correspondence: [*] Address for correspondence: Dr. Amruta Pendse, Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, Australia. Address: 2, Eurdein Lane, Wagga Wagga, NSW 2650. Tel.: +61 402653360; Fax: +61 893401266; E-mail: [email protected].

Abstract: OBJECTIVE:To compare outcomes of hospitalized preterm infants following previable prelabour rupture of membranes (PPROM) at≤23 weeks of gestation. METHODS:Retrospective cohort study of preterm infants admitted for intensive care, between January 2006 and December 2016 following PPROM, was conducted. Short term clinical outcomes included severity of respiratory morbidity, length of hospital stay and mortality. Neurodevelopment in survivors was assessed using Bayley’s Scales of Infant Development (3rd edition) at 24 months corrected age. RESULTS:A total of 82 preterm infants were admitted following PPROM at < 23 weeks and were grouped as: Group 1 (n = 28) with PPROM < 20 weeks and Group 2 (n = 54) with PPROM between 20–22 + 6 weeks. Median latency following PPROM was significantly longer in Group 1 infants [69(Interquartile range (IQR): 43–74; Range (R): 25–100 vs. 29(IQR: 10–53; R: 2–72) days, p < 0.001]. Median gestation at delivery was 27.4 weeks (Group 1) vs. 25.1 weeks (Group 2). Group 1 had a significantly higher incidence of oligohydramnios [13(46.4%) vs. 8(14.8%), p = 0.002], lower Apgar scores (<7) at 5 minutes [19(67.9%) vs. 24(44.4%), p = 0.044], increased pulmonary hypoplasia [13(46.4%) vs. 5(9.3%), p < 0.001], joint contractures [3(10.7%) vs. 0, p = 0.037] and mortality [10(35.7%) vs. 7(13.0%), p = 0.016]. Neurodevelopmental outcomes at 24 months corrected age were comparable in the 36 surviving infants (9/18 vs. 27/547). CONCLUSION:Morbidity and mortality is high in infants born after previable PPROM; specifically, in those with PPROM < 20 weeks although early childhood neurodevelopmental outcomes were comparable. Larger prospective studies focussing on long term neonatal outcomes are needed to confirm these findings.

Keywords: PPROM, previable, extreme prematurity, preterm morbidity, mortality

DOI: 10.3233/NPM-190366

Journal: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 1, pp. 9-19, 2021