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Neonatal Survival and Outcomes following Periviable Rupture of Membranes
Elizabeth J Okonek1, Elizabeth V Schulz2, Kira Belzer3
1Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas.
Insights
Infants with periviable prolonged preterm premature rupture of membranes (PPROM) had a 75.5% survival rate in the military health system, similar to controls. Long-term neurodevelopmental outcomes were comparable between groups.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Neurology
Background:
- Periviable prolonged preterm premature rupture of membranes (PPROM) presents significant challenges for infant survival and long-term health.
- Expectant management of PPROM is complex, requiring specialized neonatal care.
- Understanding outcomes in the military health system (MHS) is crucial for optimizing care pathways.
Purpose of the Study:
- To determine survival rates for infants with periviable PPROM within the MHS.
- To evaluate short-term and long-term neurodevelopmental outcomes following expectant management.
- To compare outcomes with a matched control group.
Main Methods:
- Retrospective matched cohort study of infants from six military NICUs (2010-2020).
- Cases (periviable PPROM) were matched 1:1 with controls based on gestational age, birth weight, gender, and delivery proximity to membrane rupture.
- Follow-up data collected up to 48 months corrected age.
Main Results:
- Cohort survival to NICU discharge was 75.5%, not statistically different from controls (77.6%).
- Higher rates of oligohydramnios, pulmonary hypertension, and need for high-frequency ventilation observed in the PPROM cohort.
- No significant differences in early sepsis, intraventricular hemorrhage, necrotizing enterocolitis, or long-term neurodevelopmental outcomes (autism, cerebral palsy, ADHD, asthma).
Conclusions:
- Survival to NICU discharge for infants with periviable PPROM in the MHS is comparable to matched controls and higher than previously reported.
- Infants born after periviable PPROM require specialized care, including access to high-frequency ventilation and management of pulmonary hypertension.
- Expectant management does not appear to negatively impact long-term neurodevelopmental outcomes compared to controls.
Abstract:
To clarify survival for infants affected by periviable prolonged preterm premature rupture of membranes (PPROM) in the military health system (MHS). To add to current literature on outcomes following expectant management, including long-term neurodevelopment outcomes.Retrospective matched cohort review of six level 3 military neonatal intensive care units (NICUs; 2010-2020). Cases were matched 1:1 with control infants, matched by location, gender, gestational age (within 1 week), birth weight (within 300 g), and rupture of membranes (ROM) within 24 hours of delivery. Follow-up data were obtained for each infant through 48 months' corrected age or age of last documented health visit in a military treatment facility.Forty-nine infants met inclusion criteria. Mean ROM for cohort infants was 20.7 weeks, with mean latency period of 34.6 days and mean gestational age at delivery of 25.7 weeks. Cohort infants had a mean birth weight of 919 g. Cohort survival to NICU discharge was 75.5 versus 77.6% of controls (p = 0.81). Statistically significant short-term outcomes: oligohydramnios or anhydramnios at delivery (p < 0.0001), pulmonary hypertension (p = 0.0003), and high-frequency ventilation (p = 0.004) were higher in cohort infants. No differences were found regarding rates of early sepsis, intraventricular hemorrhage, surgical necrotizing enterocolitis, oxygen at 36 weeks or at discharge. No statistical difference in long-term outcomes at 18 to 48 months of age or incidence of autism, cerebral palsy, attention deficit hyperactivity disorder, or asthma.Cohort survival to discharge in the MHS was 75.5%, higher than previously reported and not different from matched controls. Infants born after periviable PPROM should deliver at centers with access to high-frequency ventilation and ability to manage pulmonary hypertension. There was no difference in long-term neurodevelopment between the groups. · Survival to NICU discharge is similar between infants exposed to periviable PPROM and controls.. · Cohort survival to discharge was 75.5%, higher than previously reported in recent literature.. · Infant with periviable PPROM should delivery at centers capable of managing pulmonary complications..
