Impact of gestational age at PPROM on the short-term outcome of children born after extreme and prolonged preterm prelabor rupture of membranes in an experienced care center

Introduction. Survival of infants born af-ter extreme PPROM (preterm prelabor rupture of membranes) has increased dra-matically in the past 20 years, up to 90% in some tertiary neonatal centres, due to the progress in neonatal cardiorespiratory management.

Known risk factors of poor outcomes are lower gestational age at PPROM and pro-longed and severe oligohydramnios. Methods. We performed a retrospective study over a 6-year-period (2009-2015), including 14 pregnant women who expe-rienced PPROM, before 25 weeks of gesta-tion, with prolonged (>14 days) and severe oligohydramnios (amniotic fluid index<5). Each live neonate was matched with a con-trol patient who was born the same year, of the same gender, with the same gesta-tional age (+/- 6 days) and who received treatment to induce fetal lung maturation at least 48 hours before birth. 

Results. Live birth rate was 14/20 (70%) and neonatal survival was 13/14 (93%). Apgar scores at 5 and 10 minutes were lower in the PPROM group (p<0.01). In-tubation was necessary for all babies with PPROM and for 5/13 (38%) of the con-trols (p < 0.01). In a subgroup analysis of the PPROM group, we found that all ba-bies with PPROM < 20 weeks presented refractory hypoxemia and required iNO (inhaled nitric oxide) administration com-pared to one in the PPROM group > 20 weeks (p < 0.01). 

In all infants requiring iNO, the oxygenation index improved dramatically and rap-idly with treatment. 

We found no difference in the rate of bron-chopulmonary dysplasia, necrotizing en-terocolitis, retinopathy of prematurity or intraventricular hemorrhage. Conclusion. PPROM before 20 weeks of gestation exposes the neonate to a high risk of refractory hypoxemia compared to PPROM after 20 weeks. The initial care management requires more aggressive treatment with administration of iNO in all of them. 

After the initial period, the evolution of all babies born after PPROM is comparable to that of their controls.

preterm prelabor rupture of membranes, oligohydramnios, pulmonary hypertension, pulmonary hypoplasia

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