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Randomized Controlled Trial
. 2014 Sep;211(3):308.e1-6.
doi: 10.1016/j.ajog.2014.05.030. Epub 2014 May 22.

Neonatal and early childhood outcomes following early vs later preterm premature rupture of membranes

Tracy Ann Manuck  1 , Michael Walter Varner  1
Affiliations
Randomized Controlled Trial

Neonatal and early childhood outcomes following early vs later preterm premature rupture of membranes

Tracy Ann Manuck et al. Am J Obstet Gynecol. 2014 Sep.

Abstract

Objective: Data regarding long-term outcomes of neonates reaching viability following early preterm premature rupture of membranes (PPROM; <25.0 weeks at rupture) are limited. We hypothesized that babies delivered after early PPROM would have increased rates of major childhood morbidity compared with those with later PPROM (≥25.0 weeks at rupture).

Study design: This was a secondary analysis of a multicenter randomized controlled trial of magnesium sulfate vs placebo for cerebral palsy prevention. Women with singletons and PPROM of 15-32 weeks were included. All women delivered at 24.0 weeks or longer. Those with PPROM less than 25.0 weeks (cases) were compared with women with PPROM at 25.0-31.9 weeks (controls). Composite severe neonatal morbidity (sepsis, severe intraventricular hemorrhage, periventricular leukomalacia, severe necrotizing enterocolitis, bronchopulmonary dysplasia, and/or death) and composite severe childhood morbidity at age 2 years (moderate or severe cerebral palsy and/or Bayley II Infant and Toddler Development scores greater than 2 SD below the mean) were compared.

Results: A total of 1531 women (275 early PPROM cases) were included. Demographics were similar between the groups. Cases delivered earlier (26.6 vs 30.1 weeks, P < .001) and had a longer rupture-to-delivery interval (20.0 vs 10.4 days, P < .001). Case neonates had high rates of severe composite neonatal morbidity (75.6% vs 21.8%, P < .001). Children with early PPROM had higher composite severe childhood morbidity (51.6% vs 22.5%, P < .001). Early PPROM remained associated with composite severe childhood morbidity in multivariable models, even when controlling for delivery gestational age and other confounders.

Conclusion: Early PPROM is associated with high rates of neonatal morbidity. Early childhood outcomes at age 2 years remain poor compared with those delivered after later PPROM.

Keywords: childhood outcomes; neonatal outcomes; preterm premature rupture of membranes.

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Figures

FIGURE
FIGURE
Eligibility and inclusion in current study Manuck. Outcomes following early PPROM. Am J Obstet Gynecol 2014.
See this image and copyright information in PMC

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