Premature rupture of the membranes (PROM): a neonatal approach

The risks to the infant following prolonged premature rupture of the amniotic membranes are those of prematurity and infection. After the 36th week of pregnancy, healthy infants of healthy mothers may be treated as uninfected neonates, as their risk of infection does not appear to be significant. Before this gestational age, infants should receive a complete laboratory evaluation for infection, including blood culture and spinal fluid examination, and antibiotic therapy should not be withheld until these laboratory tests are reported to the clinician. While the indiscriminate use of antibiotic treatment should be avoided, sepsis in the newborn can be a rapidly progressive disease, with minimal physical and laboratory findings at its onset. Therefore, until some method of laboratory evaluation that will detect all cases of neonatal sepsis rapidly, and leave no infected infant unidentified, the clinician must be alerted to the presence of an infant delivered after PROM and institute the appropriate evaluation and treatment as soon as possible.