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Long-Term Neurodevelopmental Outcomes at 5 Years in Preterm Infants Born at <27 Weeks' Gestational Age following
Sarah Tougas1,2, Harkirat Bhullar1,2, Amelie Stritzke1,2
1Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
Preterm premature rupture of membranes (PPROM) was not associated with increased death or neurodevelopmental impairment (NDI) in infants born before 27 weeks gestation. Neurodevelopmental outcomes at 5 years were similar between infants with and without PPROM.
Area of Science:
- Neonatal care
- Perinatal medicine
- Developmental pediatrics
Background:
- Preterm premature rupture of membranes (PPROM) is a significant concern in high-risk pregnancies.
- Understanding the long-term neurodevelopmental outcomes associated with PPROM in extremely preterm infants is crucial for clinical management and parental counseling.
Purpose of the Study:
- To investigate the association between PPROM and neurodevelopmental impairment (NDI) at 5 years of age in infants born before 27 weeks of gestation.
- To compare the composite outcome of death or NDI between infants with and without PPROM.
Main Methods:
- A cohort of infants born before 27 weeks gestational age (GA) between 2005-2014 and 2017-2018 were assessed at 5 years.
- Neurodevelopmental outcomes included muscle tone, hearing, vision, and cognitive assessments.
- Univariate and multivariable regression models, including propensity score-matched analyses, were used to compare PPROM and No PPROM groups.
Main Results:
- Of 566 infants, 226 (40%) were in the PPROM group and 340 (60%) in the No PPROM group.
- After adjusting for confounders, the odds ratio for death or NDI in the PPROM group was 1.14 (95% CI: 0.82-1.58).
- No significant difference in the composite outcome of death or NDI was observed between the PPROM and No PPROM groups.
Conclusions:
- PPROM may not be associated with an increased risk of death or neurodevelopmental impairment at 5 years in extremely preterm infants.
- These findings suggest that PPROM status alone may not be a primary determinant of long-term neurodevelopmental outcomes in this vulnerable population.
- Further research could explore other contributing factors to neurodevelopmental outcomes in extremely preterm infants.
Abstract:
This study aimed to determine the association between preterm premature rupture of membranes (PPROM) and neurodevelopmental outcomes at 5 years of age in infants born before 27 weeks of gestation.Infants born before 27 weeks of gestational age (GA) between 2005 to 2014 and 2017 to 2018 and evaluated at the neonatal follow-up clinic at age 5 years were included. Outcomes were assessed based on abnormal muscle tone, hearing and vision assessments, and cognitive assessment on standardized testing. Perinatal/neonatal characteristics and outcomes were compared between the PPROM (ruptured membranes >1 hour prior to onset of contractions) and No PPROM groups using univariate tests and multivariable regression models. The primary outcome was a composite of death or neurodevelopmental impairment (NDI) at 5 years of age. NDI was considered present if a child had any of cerebral palsy, full-scale intelligence quotient >1 standard deviation below the mean, sensorineural hearing loss, or corrected visual acuity < 20/60 in the better eye.A total of 566 eligible infants were followed up in our regional follow-up clinic at 5 years of age. A total of 226 (40%) were in the PPROM group and 340 (60%) were in the No PPROM group. Infants in the PPROM and No PPROM groups had mean birth weights of 758 (±141) and 740 (±159) grams, respectively, and a median GA of 25 (range: 22-26) weeks for both groups. After adjusting for confounders, the odds ratio of death or NDI in the PPROM group were 1.14 (95% confidence interval: 0.82-1.58). The study also provided comprehensive evaluations of the primary and secondary outcomes through propensity score-matched analyses.Our study suggests that PPROM may not be associated with an increased risk of a composite outcome of death or NDI at 5 years of age in preterm infants born before 27 weeks of GA. · We compared infants born < 27 weeks GA with and without PPROM.. · Infants were assessed at 5 years of age for NDI.. · There was no difference in death or NDI between groups..
