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Prolonged premature rupture of membranes in the preterm infant: a 7 year study
1Department of Child Life and Health, University of Edinburgh, UK.
Insights
Pulmonary hypoplasia is a significant risk for preterm infants with prolonged membrane rupture, but infection is less common. Even with extended rupture, pulmonary hypoplasia is not always inevitable.
Area of Science:
- Neonatal Medicine
- Perinatology
- Pediatric Pulmonology
Background:
- Prolonged and preterm rupture of membranes (PPROM) presents significant risks to neonates.
- Understanding the outcomes associated with PPROM is crucial for clinical management.
Purpose of the Study:
- To investigate the outcomes of preterm infants born after prolonged and preterm rupture of membranes.
- To identify the primary causes of mortality and morbidity in this vulnerable population.
Main Methods:
- A retrospective and partially prospective observational study.
- Inclusion of 117 preterm infants (gestation 25-36 weeks) with ruptured membranes >4 days.
- Data collection focused on survival, causes of death, compression deformities, pulmonary hypoplasia, and infection.
Main Results:
- Pulmonary hypoplasia and prematurity were the leading causes of death (11 deaths each).
- Compression deformities occurred in 25 infants, with longer membrane rupture duration associated with higher incidence.
- While pulmonary hypoplasia was linked to longer rupture durations, survival was still possible even after extended periods.
Conclusions:
- Pulmonary hypoplasia poses a greater threat than infection in neonates with PPROM.
- Pulmonary hypoplasia is not an inevitable outcome, even with prolonged membrane rupture.
Aim:
To review the outcome of infants born following prolonged and preterm rupture of the membranes.
Design:
retrospective and partially prospective observational study.
Setting:
babies born in and referred to a tertiary neonatal centre.
Patients:
117 preterm infants, median gestation (range) = 29.5 (25-36) weeks, seen over a 7 year period with membranes ruptured for more than 4 days; median (range) = 9 (4-119) days.
Outcome Measures:
survival and cause of death, compression deformities, pulmonary hypoplasia and infection.
Results:
23 infants died, 11 from pulmonary hypoplasia and 11 as a direct consequence of prematurity (3 from hyaline membrane disease, 7 from bronchopulmonary dysplasia and one from necrotising enterocolitis developed on day 17). One infant had a lethal congenital abnormality and died untreated of overwhelming infection. No other infants died of infection. 94% of infants were treated with broad-spectrum antibiotics after birth. Compression deformities were seen in 25 infants: median duration of membrane rupture 28 days, range 4-119. In those without deformity, median duration was 7 days, range 4-105. Sixteen infants had pulmonary hypoplasia (median 31, range 14-119), 11 died (median 37, range 21-112) and five survived (median 23, range 14-119). Although the median duration of membrane rupture in infants dying of pulmonary hypoplasia was longer than in those who did not have hypoplasia (31 compared to 7 days), 13 of 27 (48%) of infants whose membranes were ruptured for 4 weeks and 4 of 7 (57%) whose membranes were ruptured more than 70 days survived.
Conclusion:
death from pulmonary hypoplasia is a much more serious problem following preterm prolonged membrane rupture than is infection. Pulmonary hypoplasia is not inevitable even after prolonged periods of membrane rupture.