Staff Neonatologist Hospital La Paz Oviedo, Asturias, Spain
Background: Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and it is the direct cause of around a quarter of all preterm births. It has been associated with adverse perinatal outcomes, but the interaction between timing of PPROM, the latency until delivery and their impact on neonatal outcomes is still not fully understood. Objective: The aim of this study was to describe the timing and latency of preterm prolonged rupture of membranes in extremely preterm infants and analyze its impact on mortality and bronchopulmonary dysplasia (BPD). Design/Methods: Observational, multicenter study using prospectively collected population data from 75 NICUs in Spain, participating in the Spanish Neonatal Society SEN1500 network database. Extremely preterm infants < 28 weeks born between 2012 and 2022 were included in the study when information about timing of rupture of membranes (ROM) and delivery, as well as short term outcome data, were available. Demographic and clinical data were retrieved. Survival tables were created according to timing of ROM and gestational age (GA) at birth. Primary outcome was survival without BPD defined as need for oxygen or respiratory support at 36 weeks. Multivariate logistic regression models were developed to account for possible confounders. Results: A total of 7441 extremely preterm newborns were included in the study. Mean GA was 26 weeks (IQR 25-27) and mean birth weight was 800 g (IQR 680-960). Overall, 33.8% infants had rupture of membranes more than 24 hours prior to delivery, 21.2% had it more than 1 week prior to delivery, and 11.7% had it more than 28 days prior to delivery. Overall survival without BPD was 42.0% and overall survival was 69.8%. Survival according to the timing of ROM and the gestational age at birth is detailed in Table 1. In multivariate logistic regression models corrected by GA, complete course of antenatal steroids, C-Section and diagnosis of chorioamnionitis, total weeks of rupture of membranes were associated with decreased survival without BPD (OR 0.88, CI 95% 0.84-0.93), increased mortality (OR 1.08, CI 95% 1.03-1.14) and increased BPD (OR 1.06, CI 95% 1.01-1.11). Gestational age at rupture of membranes was also independently associated, after adjusting for the same confounders, with decreased survival without BPD (OR 1.13, CI 95% 1.08-1.19) and increased mortality (OR 0.92, CI 95% 0.88-0.97) and BPD (OR 0.94, CI 95% 0.90-0.99).
Conclusion(s): Latency of PPROM and gestational age at ROM were independently associated with decrease survival without BPD, as well as decreased survival.
