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Mortality and morbidity of neonates with pulmonary hypoplasia resulting from preterm prolonged rupture of membranes

Presented at the Neonatal Society 2007 Summer Meeting (programme).

Rhodes L, Doherty C

Department of Neonatology, University Hospital of Wales (UHW), Cardiff, UK

Background: While there has been much research into neonatal outcomes following pPROM (1,2), this case-series looks specifically at neonatal outcomes following very early pPROM.

Objective: To examine the outcome of early pPROM (<26 weeks gestation) on perinatal mortality and morbidity within a Welsh tertiary fetal and neonatal service.

Methods: 34 women with spontaneous rupture of membranes at <26 weeks gestation between January 2001 and December 2004 were identified using a standard obstetric database. Exclusion criteria included those with no documented date of SROM, those lost to follow-up and those with a latency period <4 days. This left 28 subjects. Demographics examined included maternal age, gestation at rupture, latency period and mean amniotic fluid volume (AFI). Neonatal outcomes measured were gender, birth weight, mortality and morbidity including pulmonary hypoplasia, RDS, CLD, length of hospital stay and number of readmissions in the first two years of life. For analysis subjects were stratified into two groups: the first being those with SROM at <20 weeks and the second being those with SROM between 20-26 weeks. This was undertaken in accordance with UK ethical guidelines.

Results: Demographics were well matched for the two groups. All results are stated excluding elective terminations of which there were 26.3% in the first group and 11% in the second group which shows a statistically significant difference between the two groups. There was also a statistically significant difference between the 2 groups for mortality and survival (Mortality <20w: 71.4%, 20-26w: 50%) while 42.9% of the first group and 50% of the second group had a diagnosis of pulmonary hypoplasia. Overall 45.5% of subjects were diagnosed with pulmonary hypoplasia with 40% surviving past discharge. It was noted that all those with a gestational age at delivery of <28weeks died perinatally while 80% of those born at >28weeks gestation survived past discharge. All survivors had chronic lung disease or respiratory distress syndrome. The first group had a statistically significant longer length of stay in the NNU at 73 (68-82) days compared to 20 (4-44) days in the second group. The 5 minute APGARS were 5 (1-10) in the first group and 2.5 (2-3) in the second group. There was not a statistically significant difference between the two groups with regards to the number of readmissions in the first two years of life.

Conclusions: There was a worse prognosis with earlier pPROM (<20 weeks) and delivery <28 weeks gestation. A prospective UK study on outcome of very early pPROM (including TOPs) would provide greater numbers and allow for more accurate antenatal counselling.

1. Pena SDJ, Shokier MHK, Journal of Paediatrics, 85:373, 1974
2. Avi Rotschild et al, American Journal of Obstetrics and Gynaecology, 162(1):pp46-52

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