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Published on: November 20, 2015
Neonatal and two-year outcomes after rupture of membranes before 25 weeks of gestation
Juliana Patkai1, Thomas Schmitz, Olivia Anselem
1Neonatal Intensive Care Unit, Groupe Hospitalier Cochin Port Royal Saint Vincent de Paul, APHP, Université Paris Descartes, Paris, France.
Insights
Extreme preterm premature rupture of membranes (PPROM) before 25 weeks significantly increases adverse neonatal outcomes. Infants exposed to PPROM also face higher risks of developmental delays and behavioral issues at two years.
Area of Science:
- Perinatal Medicine
- Neonatology
- Developmental Pediatrics
Background:
- Extreme preterm premature rupture of membranes (PPROM) before 25 weeks gestation presents significant challenges in perinatal care.
- Understanding the long-term impact of PPROM on preterm infant outcomes is crucial for clinical management and parental counseling.
Purpose of the Study:
- To evaluate the impact of PPROM at less than 25 weeks gestation on neonatal and two-year child outcomes.
- To compare outcomes of infants with extreme PPROM to a matched control group.
Main Methods:
- Retrospective study conducted in a tertiary care center in Paris, France (2003-2007).
- Inclusion criteria: singleton pregnancies with PPROM between 15 and 24 weeks gestation.
- Control group: matched neonates born after spontaneous preterm labor with intact membranes.
Main Results:
- 22 live births occurred among 78 cases of extreme PPROM, with a mean gestational age of 26 5/7 weeks.
- Adverse neonatal outcomes were significantly higher in the PPROM group (68.2%) compared to controls (27.3%).
- At two years, PPROM infants showed increased delayed acquisitions (64.3% vs 15.8%), behavioral disorders (57.1% vs 15.8%), and lower language scores (78.9 vs 96.8).
Conclusions:
- PPROM before 25 weeks is linked to increased neonatal mortality and morbidity.
- Infants exposed to extreme PPROM face elevated risks of developmental delays, behavioral disorders, and impaired language development at two years.
- These findings underscore the severe consequences of early PPROM and the need for specialized follow-up care.
Objective:
To assess the impact of extreme preterm premature rupture of membranes (PPROM) <25 weeks of gestation on preterm child outcome.
Study Design:
Retrospective study comparing the neonatal and 2-year outcomes of infants exposed to extremely PPROM <25 weeks with a non-exposed group of neonates in a tertiary care referral centre located in Paris, France, between 2003 and 2007. All women with singleton pregnancy and PPROM between 15(0/7) and 24(6/7) weeks of gestation were recruited. For each infant born alive, the next inborn neonate matched for gestational age and sex was selected as a control among neonates born alive after spontaneous preterm labour with intact membranes. The main outcome measures were neonatal outcome assessed by a combined criterion of adverse neonatal outcomes and the two-year neurodevelopmental outcome assessed by developmental Brunet-Lézine tests and neurological examinations.
Results:
In 78 cases of extremely PPROM, 22 live births occurred at a mean gestational age of 26(5/7) weeks. The percentage of neonates with adverse neonatal outcomes was significantly higher among PPROM than non-exposed cases (68.2 versus 27.3%). At 2 years of age, children from the PPROM group were more likely to have delayed acquisitions (64.3 versus 15.8%) and behavioural disorders (57.1 versus 15.8%). Mean Brunet-Lézine language score was significantly lower among those infants (78.9 versus 96.8).
Conclusion:
PPROM <25 weeks is associated with increased neonatal mortality and morbidity and with increased risks of delayed acquisitions, behavioural disorders and lower language performance scores at 2 years in comparison with matched preterm neonates born after spontaneous preterm labour with intact membranes.
