Neonatal outcome after very prolonged and premature rupture of membranes

Very premature and prolonged rupture of the membranes (VPPROM) for at least 5 days is associated with an increased incidence of perinatal infection and lung hypoplasia. There is, however, limited information about outcome of premature neonates born after VPPROM uncomplicated by oligohydramnios. The present study compared the outcome, in three categories of neonates born before 34 weeks gestation: group I, VPPROM without oligohydramnios (n = 28); group II, VPPROM with oligohydramnios (n = 14); and group III, the comparison group without VPPROM (n = 39). Mortality in group I (2 of 28) was similar to that in group III (6 of 39) and was lower than that in group II (5 of 14). Lung hypoplasia and limb deformities were not more frequent in group I than in group III (2 of 28 and 0 of 28 versus 3 of 39 and 1 of 39, respectively) but occurred more frequently only in group II (5 of 14 and 4 of 14). All deaths in groups I and II were accounted for by lung hypoplasia. There was no difference between the groups for asphyxia, (respiratory distress syndrome, air leaks, bronchopulmonary dysplasia, or intracranial bleeding. Neonatal infection was more frequent in group I (4 of 14, 28.6%) and group II (7 of 28, 25%) when compared with group III (2 of 39, 5%). Within groups I and II rupture of the membranes was not more prolonged in the neonates with infection (median, 9.7 days) compared with the neonates without infection (median, 9.6 days). In conclusion, when VPPROM is not complicated by oligohydramnios, mortality, lung hypoplasia, and limb deformities are not more frequent than in control neonates of similar gestational age. As shown by others, the present data support the fact that VPPROM is associated with an increased risk of perinatal infection, but this is not responsible for the poor outcome.