Neonatal outcomes following previable rupture of membranes below 23 weeks' gestation

This study aimed to provide institution-specific, up-to-date data to improve counseling for pregnant women experiencing preterm premature rupture of membranes (pPROM) before or at the limit of viability. We conducted a retrospective cohort study (2009-2022) of preterm infants with pPROM < 23 + 0 weeks' gestation who received active neonatal care. The primary outcomes were survival and survival without severe short-term morbidity (defined as IVH III, PVHI, cPVL, and/or ROP). Data from 109 patients with a median gestational age at pPROM of 21.6 weeks and a median gestational age at delivery of 25.4 weeks were analyzed. The overall survival rate was 69.7%, and survival without short-term severe morbidity was 51.4%. Both outcomes improved significantly with increasing gestational age at birth. Early-onset neonatal sepsis (culture-positive and culture-negative) occurred in 18.3% of cases, with its risk inversely correlated with both gestational age at birth and latency until delivery. Higher gestational age at pPROM (aOR 1.945 (95% CI 1.193-3.171) per week) and longer latency until delivery (aOR 1.115 (95% CI 1.060-1.173) per day) were significant predictors of survival without severe morbidity.

Our study provides valuable, institution-specific data on outcomes for infants born after pPROM < 23 + 0 weeks' gestation. Gestational age at pPROM and latency until delivery are key predictors of survival and survival without severe morbidity in preterm infants. These results offer important insights for counseling pregnant women experiencing pPROM at or near the limit of viability.

• Counseling patients after previable pPROM 23+0 weeks is challenging due to limited data. • Outcomes vary widely between centers.

• Institution-specific survival after previable pPROM with active management was 69.7%; gestational age at pPROM and latency until delivery independently predicted intact survival. • Early-onset neonatal sepsis risk decreased with longer latency despite prolonged membrane rupture.