Effect of premature rupture of membranes on maternal infections and outcome of preterm infants
WU Tian, SHI Jing, BAO Shan, QU Yi, MU De-Zhi
Department of Pediatrics, West China Second University Hospital/Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu 610041, China
Abstract：Objective To investigate the effect of premature rupture of membranes (PROM) on maternal infections and outcome of preterm infants.Methods A total of 441 preterm infants and 387 mothers were enrolled as subjects. According to the presence or absence of PROM, the mothers were divided into non-PROM group with 104 mothers, PROM duration < 72 hours group with 90 mothers, and PROM duration ≥72 hours group with 193 mothers. The three groups were compared in terms of clinical features of mothers and infants and complications.Results Compared with the control group and the PROM duration < 72 hours group, the PROM duration ≥72 hours group had significantly higher maternal age, incidence rate of umbilical vasculitis, and rate of antibiotic use; the PROM duration ≥72 hours group had a significantly higher incidence rate of moderate-to-severe chorioamnionitis than the control group (P < 0.05), while there was no significant difference between the PROM duration ≥72 hours group and the PROM duration < 72 hours group (P > 0.05). Compared with the control group and the PROM duration < 72 hours group, the PROM duration ≥72 hours group had significantly higher incidence rates of pneumonia and intracranial hemorrhage in preterm infants; the PROM duration ≥72 hours group had a significantly higher incidence rate of congenital infection and a significantly longer mean length of hospital stay compared with the control group (P < 0.05), while there were no significant differences between the PROM duration ≥72 hours group and the PROM duration < 72 hours group (P > 0.05). The multivariate analysis showed that PROM duration ≥72 hours was an independent risk factors for pneumonia (OR=2.200, 95%CI: 1.386-3.492) and intracranial hemorrhage (OR=2.331, 95%CI: 1.420-3.827) in preterm infants.Conclusions PROM duration ≥72 hours significantly increases the risk of placental infection in mothers and it is an independent risk factor for pneumonia and intracranial hemorrhage in preterm infants.
WU Tian,SHI Jing,BAO Shan et al. Effect of premature rupture of membranes on maternal infections and outcome of preterm infants[J]. CJCP, 2017, 19(8): 861-865.
Zhou Q, Zhang W, Xu H, et al. Risk factors for preterm premature rupture of membranes in Chinese women from urban cities[J]. In J Gynaecol Obset, 2014, 127 (3): 254-259.
Drassinower D, Friedman AM, Običan SG, et al. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis[J]. Am J Obstet Gynecol, 2015, 212 (1): S161-S162.
Nayot D, Penava D, Da SO, et al. Neonatal outcomes are associated with latency after preterm premature rupture of membranes[J]. J Perinatol, 2012, 32 (12): 970-977.
[6]
Ekin A, Gezer C, Taner CE, et al. Risk factors and perinatal outcomes associated with latency in preterm premature rupture of membranes between 24 and 34 weeks of gestation[J]. Arch Gynecol Obstet, 2014, 290 (3): 449-55.
[7]
Levy A, Wiznitzer A, Mazor M, et al. Factors affecting the latency period in patients with preterm premature rupture of membranes[J]. Arch Gynecol Obstet, 2011, 283 (4): 707-710.
Holzman C, Senagore PK, Wang J. Mononuclear leukocyte infiltrate in extraplacental membranes and preterm delivery[J]. Am J Epidemiol, 2013, 177 (10): 1053-64.
[10]
Pappas A, Kendrick DE, Shankaran S, et al. Chorioamnionitis and early childhood outcomes among extremely low-gestational-age neonates[J]. JAMA Pediatr, 2014, 168 (2): 137-147.
Menon R, Boldogh I, Hawkins HK, et al. Histological evidence of oxidative stress and premature senescence in preterm premature rupture of the human fetal membranes recapitulated in vitro[J]. Am J Pathol, 2014, 184 (6): 1740-1751.
[13]
Hackenhaar AA, Albernaz EP, da Fonseca TM. Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections[J]. J Pediatr (Rio J), 2014, 90 (2): 197.
Lu HY, Zhang Q, Wang QX, et al. Contribution of histologic chorioamnionitis and fetal inflammatory response syndrome to increased risk of brain injury in infants with preterm premature rupture of membranes[J]. Pediatr Neurol, 2016, 61: 94-98.e1.
Drassinower D, Friedman AM, Običan SG, et al. Prolonged latency of preterm premature rupture of membranes and risk of neonatal sepsis[J]. Am J Obstet Gynecol, 2015, 214 (6): 743.e1-6.
[22]
Cetin O, Aydın ZD, Verit FF, et al. Is maternal blood procalcitonin level a reliable predictor for early onset neonatal sepsis in preterm premature rupture of membranes[J]. Gynecol Obstet Invest, 2017, 82 (2): 163-169.
[23]
Jobe AH. Effects of chorioamnionitis on the fetal lung[J]. Clin Perinatol, 2012, 39 (3): 441-457.
[24]
Kim SK, Romero R, Savasan ZA, et al. Endoglin in amniotic fluid as a risk factor for the subsequent development of bronchopulmonary dysplasia[J]. Am J Reprod Immunol, 2013, 69 (2): 105-123.
