13 - Outcomes of Extremely Preterm Infants Exposed to Prolonged Preterm Prelabor Rupture of Membranes before 24 Weeks of Gestation

Poster Number: 13
Publication Number: 13.337

Noelle Younge, Duke University School of Medicine, Durham, NC, United States; Shampa Saha, RTI International, RTP, NC, United States; Jane E. Brumbaugh, Mayo Clinic, Rochester, MN, United States; Jonathan M. Klein, University of Iowa Stead Family Children's Hospita, Iowa City, IA, United States; Edward F. Bell, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States; Tarah Colaizy, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, United States; Brenna L. Hughes, Duke University School of Medicine, Durham, NC, United States; William Malcolm, Duke University School of Medicine, Durham, NC, United States; Myra H. Wyckoff, University of Texas Southwestern Medical School, Dallas, TX, United States; Krisa P. Van Meurs, Stanford University School of Medicine, Palo Alto, CA, United States; Michele Walsh, NICHD, Bethesda, MD, United States; Abhik Das, RTI International, North Potomac, MD, United States; Michael Cotten, Duke University School of Medicine, Durham, NC, United States

Background: Preterm prelabor rupture of membranes (PPROM) before or near the limit of viability is associated with serious maternal and neonatal complications including chorioamnionitis, extremely preterm (EPT; < 27 weeks’ gestation) birth, and pulmonary hypoplasia. Clinical guidelines recommend that care teams provide families a realistic appraisal of neonatal outcomes to guide shared decision making, yet few studies have described outcomes of EPT infants born after periviable PPROM.

Objective: To describe contemporary outcomes of EPT infants exposed to prolonged PPROM at < 24 weeks’ gestation, and to identify perinatal factors associated with survival without severe neurodevelopmental impairment (NDI).

Design/Methods: Survival and survival without severe NDI (defined as severe cerebral palsy, Gross Motor Function Classification level 4-5, Bayley-III cognitive composite < 70, or severe bilateral vision or hearing loss) at 22-26 months’ corrected age were compared between EPT infants of mothers with prolonged (≥120 hours) PPROM at < 24 weeks’ gestation and EPT infants of mothers with rupture of membranes (ROM) ≤18 hours before delivery in NICHD Neonatal Research Network centers between 2012-2018, adjusting for birth gestational age (GA), sex, multiple gestation, antenatal steroids, small for GA, insurance, and center. Cases with ROM >18 to < 120 hours and infants not actively treated were excluded. Regression models were used to identify factors associated with survival and survival without severe NDI among infants exposed to prolonged PPROM.

Results: Among 609 infants born after prolonged PPROM, the median GA at ROM was 22.3 weeks and latency duration was 13 days. Multiple factors differed between infants exposed to prolonged PPROM and unexposed infants, including higher rates of pneumothorax and early-onset sepsis in the PPROM group (Table 1). Odds of survival and survival without severe NDI were not significantly different between groups (Table 2). In the prolonged PPROM group, 444/608 (73%) infants survived and 298/533 (56%) infants survived without severe NDI. Higher GA at birth and at ROM were associated with higher odds of survival without severe NDI, while small for GA infants had lower odds of survival without severe NDI (Table 3).Conclusion(s): Most EPT infants born to mothers with prolonged, periviable PPROM survived without severe NDI. Odds of survival without severe NDI were not significantly different from infants not exposed to prolonged PPROM, but decreased with earlier GA at ROM.
Table 1. Maternal and Neonatal Characteristics and Treatments
Table 2. Outcomes at 22-26 Months' Corrected Age