Neonatal mortality and morbidity after aggressive long-term tocolysis for preterm premature rupture of the membranes

Abstract

Objective: To test the hypothesis that predischarge morbidity and mortality are not increased for infants admitted to our neonatal intensive care unit and whose mothers had tocolysis for >48 h plus antibiotics and steroids (aggressive long-term tocolysis) after preterm premature rupture of the membranes (PPROM) as compared with gestational age-matched infants born to mothers not treated for PPROM.

Methods: A retrospective cohort study was conducted on live preterm births (<or=36.0 weeks) admitted to the neonatal intensive care unit between January 1, 1999 and June 30, 2003, comparing singletons born to mothers with PPROM+tocolysis for >48 h (n=137, group 1) with singletons born to all other mothers matched for group-1 gestational age at delivery (n=628, group 2), excluding severe maternal complications such as insulin-dependent diabetes and preeclampsia in both groups. Primary outcome was the predischarge mortality and morbidity of the neonates.

Results: In the group with post-PPROM tocolysis which lasted for 14.4+/-14.0 days with a latency of 15.3+/-15.3 days (time from PPROM to delivery) and 14.4+/-14.0 days (time from the start of tocolysis to delivery), the predischarge mortality and morbidity was not increased compared to the non-treated group. The 1- and 10-min Apgar scores of between 1 and 7 were less frequent with tocolysis (p<0.05), and oxygen use was less frequent (26.3 vs. 36.3%, p=0.03) and shorter (8.7 vs. 19.6 days, p=0.03). However, amniotic fluid infection syndrome and latency (i.e. >1 week) are the most potential predictors of the respiratory distress syndrome in addition to gestational age at delivery in pregnancies with post-PPROM tocolysis.

Conclusions: Amniotic fluid infection syndrome and a latency of >1 week achieved by aggressive post-PPROM tocolysis lessens the advantages of extended gestational age and decreased predischarge neonatal morbidity. These findings may have important implications for the clinical management of PPROM.