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Chronic respiratory morbidity after prolonged and premature rupture of the membranes
P J Thompson1, A Greenough, K Nicolaides
1King's College Hospital, London, Department, Child Health.
Insights
Infants born after second-trimester membrane rupture face recurrent respiratory issues, particularly if delivered very preterm or requiring neonatal ventilation. Avoiding very preterm delivery is key to preventing chronic respiratory problems in these survivors.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Pulmonology
Background:
- Second-trimester premature rupture of membranes (PROM) is a high-risk pregnancy complication.
- Infants born after PROM face potential long-term health challenges, including respiratory issues.
Purpose of the Study:
- To investigate the incidence and risk factors of recurrent respiratory problems in infants surviving second-trimester PROM.
- To compare respiratory morbidity in infants with and without a history of PROM.
Main Methods:
- Follow-up study of 21 infants born after second-trimester PROM lasting at least one week.
- Assessment of recurrent respiratory symptoms (wheezing, coughing) and hospital admissions for respiratory disorders.
- Analysis of associations with neonatal ventilation, preterm delivery, birth weight, and PROM duration.
Main Results:
- 24% of infants experienced recurrent respiratory problems, significantly linked to neonatal ventilation and very preterm delivery.
- 28% of preterm, low birth weight infants (<2500g) had recurrent respiratory symptoms.
- This incidence was lower than in infants born after pregnancies without PROM.
Conclusions:
- Very preterm delivery is the primary preventable factor for chronic respiratory morbidity in survivors of second-trimester PROM.
- The timing and duration of PROM did not significantly correlate with respiratory symptoms.
- Strategies should focus on optimizing gestational age to mitigate long-term respiratory health issues.
Abstract:
Twenty one surviving infants of pregnancies complicated by rupture of the membranes during the second trimester that lasted at least one week have been followed up for a median of 15 months. Five infants (24%) had recurrent respiratory problems (episodes of wheezing and coughing occurring at least once a week) which related significantly to the use of neonatal ventilation and to very preterm delivery. Five of the 18 infants who were born preterm and with birth weights of less than 2500 g had recurrent respiratory symptoms (28%). This compares favourably with an incidence of symptoms of 67% among surviving low birthweight infants born at this hospital after pregnancies not complicated by premature rupture of the membranes. Neither recurrent respiratory symptoms nor admission to hospital for chest related disorders were associated with the timing of onset or duration of rupture of the membranes. We conclude that, among survivors of premature rupture of the membranes, chronic respiratory morbidity would best be prevented by avoiding very preterm delivery, regardless of the duration of the rupture.