Objective To determine the hospital outcomes of liveborn infants at 23–31 weeks following prelabour preterm rupture of membranes (PPROM).
Method A regional retrospective cohort study of 4454 infants of 23–31 weeks’ gestation admitted to a tertiary neonatal network between 2007 and 2011. Primary outcome was the composite chronic lung disease (CLD) or mortality at discharge.
Results 225 (5%) neonates had a history of PPROM occurring prior to 24+0 weeks (Early-PPROM), 829 (19%) had a history of PPROM at or after 24+0 weeks’ gestation (Late-PPROM) and 3400 (76%) had no history of PPROM (No-PPROM). In comparison to No-PPROM, Early-PPROM group had higher CLD/mortality in infants born at 23–27 weeks (OR 1.95; 95% CI 1.34 to 2.85) and 28–31 weeks (OR 4.98; 95% CI 2.99 to 8.28). Within Early-PPROM group, the latency of PPROM >14 days had lower CLD/mortality in comparison to latency ≤14 days (57.6% vs 77%, OR 0.40; 95% CI 0.21 to 0.76). Late-PPROM group had significantly lower CLD/mortality in comparison to No-PPROM group at 23–27 weeks (OR 0.50; 95% CI 0.37 to 0.69) and 28–31 weeks (OR 0.50; 95% CI 0.36 to 0.71). Within Late-PPROM group, latency >14 days was associated with an increased CLD/mortality in 28–31 weeks (14.1% vs 5.4%, OR 2.88; 95% CI 1.31 to 6.38).
Conclusions Early-PPROM prior to 24 weeks’ gestation had high incidence of CLD/mortality even after correcting for gestational age. Late-PPROM at or after 24 weeks had lower CLD/mortality compared with No-PPROM. Latency >14 days in Late-PPROM group at 28–31 week group increased the odds of CLD/mortality.
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Contributors PP conceptualised and designed the study, analysed and interpreted the data, and drafted the initial manuscript. ALM and KL contributed to the initial concept and design of the study, analysis and interpretation of data. BB designed the data collection instruments, coordinated and supervised data collection, and critically reviewed the manuscript. SB conceptualised and designed the study, coordinated and supervised data analyses and manuscript write-up, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
Competing interests None declared.
Ethics approval South Eastern Sydney and Illawarra Area Health Service Human Research Ethics Committee-Northern Sector.
Provenance and peer review Not commissioned; externally peer reviewed.
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