Clinical features of very preterm infants with prelabor rupture of membranes and predictive factors for major adverse outcomes
DONG Hui-Min, SONG Juan, JUE Zhen-Zhen, WEI Le-Le, LI Wen-Dong, ZHOU Zhu-Ye
Department of Neonatology, Third Affiliated Hospital of Zhengzhou University/Henan Key Laboratory of Child Brain Injury/Henan Pediatric Clinical Research Center, Zhengzhou 450052, China
Abstract Objective To study the clinical features of very preterm infants with prelabor rupture of membranes (PROM) and predictive factors for early-onset sepsis (EOS) and death. Methods A retrospective analysis was performed for the clinical data of the very preterm infants with PROM (with a gestational age of < 32 weeks) who were admitted to the neonatal intensive care unit from January 2018 to May 2020. According to the time from membrane rupture to delivery, the infants were divided into four groups: < 18 hours (n=107), 18 hours to < 3 days (n=111), 3 days to < 14 days (n=144), and ≥ 14 days (n=37). According to the presence or absence of EOS, the infants were divided into EOS (n=42) and non-EOS groups (n=357). According to the survival state, the infants were divided into a survival group (n=359) and a death group (n=40). Clinical features were analyzed for very preterm infants with different times of PROM. A multivariate logistic regression analysis was used to investigate the predictive factors for EOS and death in very preterm infants with PROM. Results There was no significant difference in the incidence rates of major neonatal complications and mortality rate among the very preterm infants with different times of PROM (P > 0.05). Birth weight < 1 000 g (OR=4.353, P=0.042), grade Ⅲ amniotic fluid contamination (OR=4.132, P=0.032), and grade Ⅲ-Ⅳ respiratory distress syndrome (RDS) (OR=2.528, P=0.021) were predictive factors for EOS in very preterm infants with PROM. Lower birth weights (< 1 000 g or 1 000-1 499 g; OR=11.267 and 3.456 respectively; P=0.004 and 0.050 respectively), grade Ⅲ-Ⅳ RDS (OR=5.572, P < 0.001), and neonatal sepsis (OR=2.631, P=0.012) were predictive factors for death in very preterm infants with PROM. Conclusions Prolonged PROM does not increase the incidence of neonatal complications and mortality in very preterm infants. Adverse outcomes of very preterm infants with PROM are mainly associated with lower birth weights, lung immaturity, and systemic infection.
DONG Hui-Min,SONG Juan,JUE Zhen-Zhen et al. Clinical features of very preterm infants with prelabor rupture of membranes and predictive factors for major adverse outcomes[J]. CJCP, 2021, 23(6): 575-581.
DONG Hui-Min,SONG Juan,JUE Zhen-Zhen et al. Clinical features of very preterm infants with prelabor rupture of membranes and predictive factors for major adverse outcomes[J]. CJCP, 2021, 23(6): 575-581.
Menon R, Richardson LS. Preterm prelabor rupture of the membranes:a disease of the fetal membranes[J]. Semin Perinatol, 2017, 41(7):409-419. DOI:10.1053/j.semperi.2017.07.012. PMID:28807394.
[4]
Dammann O, Leviton A, Gappa M, et al. Lung and brain damage in preterm newborns, and their association with gestational age, prematurity subgroup, infection/inflammation and long term outcome[J]. BJOG, 2005, 112(Suppl 1):4-9. DOI:10.1111/j.1471-0528.2005.00576.x. PMID:15715586.
[5]
Zhu ML, Jin YT, Duan Y, et al. Multi-drug resistant Escherichia coli causing early-onset neonatal sepsis:a single center experience from China[J]. Infect Drug Resist, 2019, 12:3695-3702. DOI:10.2147/IDR.S229799. PMID:31819551.
Puopolo KM, Mukhopadhyay S, Hansen NI, et al. Identification of extremely premature infants at low risk for early-onset sepsis[J]. Pediatrics, 2017, 140(5):e20170925. DOI:10.1542/peds.2017-0925. PMID:28982710.
Wang XL, Wang J, Yuan L, et al. Trend and causes of neonatal mortality in a level Ⅲ children's hospital in Shanghai:a 15-year retrospective study[J]. World J Pediatr, 2018, 14(1):44-51. DOI:10.1007/s12519-017-0101-y. PMID:29383582.
Ye GY, Jiang Z, Lu SM, et al. Premature infants born after preterm premature rupture of membranes with 24-34 weeks of gestation:a study of factors influencing length of neonatal intensive care unit stay[J]. J Matern Fetal Neonatal Med, 2011, 24(7):960-965. DOI:10.3109/14767058.2011.572204. PMID:21506655.
[15]
Gezer A, Parafit-Yalciner E, Guralp O, et al. Neonatal morbidity mortality outcomes in pre-term premature rupture of membranes[J]. J Obstet Gynaecol, 2013, 33(1):38-42. DOI:10.3109/01443615.2012.729620. PMID:23259876.
[16]
Lorthe E, Ancel PY, Torchin H, et al. Impact of latency duration on the prognosis of preterm infants after preterm premature rupture of membranes at 24 to 32 weeks' gestation:a national population-based cohort study[J]. J Pediatr, 2017, 182:47-52.e2. DOI:10.1016/j.jpeds.2016.11.074. PMID:28081890.
[17]
Manuck TA, Maclean CC, Silver RM, et al. Preterm premature rupture of membranes:does the duration of latency influence perinatal outcomes?[J]. Am J Obstet Gynecol, 2009, 201(4):414.e1-414.e6. DOI:10.1016/j.ajog.2009.07.045. PMID:19788972.
[18]
Lorthe E. Epidemiology, risk factors and child prognosis:CNGOF preterm premature rupture of membranes guidelines[J]. Gynecol Obstet Fertil Senol, 2018, 46(12):1004-1021. DOI:10.1016/j.gofs.2018.10.019. PMID:30385352.
[19]
Palatnik A, Liu LY, Lee A, et al. Predictors of early-onset neonatal sepsis or death among newborns born at <32 weeks of gestation[J]. J Perinatol, 2019, 39(7):949-955. DOI:10.1038/s41372-019-0395-9. PMID:31089257.
Baizat M, Zaharie G, Iancu M, et al. Potential clinical predictors of suspected early and late onset sepsis (EOS and LOS) in preterm newborns:a single tertiary center retrospective study[J]. Clin Lab, 2019, 65(7):190105. DOI:10.7754/Clin.Lab.2019.190105. PMID:31307181.
[22]
Muhe LM, Mcclure EM, Nigussie AK, et al. Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP):a prospective, cross-sectional, observational study[J]. Lancet Glob Health, 2019, 7(8):e1130-e1138. DOI:10.1016/S2214-109X(19)30220-7. PMID:31303299.
Been JV, Zimmermann LJ. Histological chorioamnionitis and respiratory outcome in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed, 2009, 94(3):F218-F225. DOI:10.1136/adc.2008.150458. PMID:19131431.
[27]
Corchia C, Ferrante P, Da Frè M, et al. Cause-specific mortality of very preterm infants and antenatal events[J]. J Pediatr, 2013, 162(6):1125-1132.E4. DOI:10.1016/j.jpeds.2012.11.093. PMID:23337093.
[28]
McGoldrick E, Stewart F, Parker R, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth[J]. Cochrane Database Syst Rev, 2020, 12:CD004454. DOI:10.1002/14651858.CD004454.pub4. PMID:33368142.
[29]
Bredeson S, Papaconstantinou J, Deford JH, et al. HMGB1 promotes a p38MAPK associated non-infectious inflammatory response pathway in human fetal membranes[J]. PLoS One, 2014, 9(12):e113799. DOI:10.1371/journal.pone.0113799. PMID:25469638.
[30]
Musilova I, Andrys C, Drahosova M, et al. Amniotic fluid prostaglandin E2 in pregnancies complicated by preterm prelabor rupture of the membranes[J]. J Matern Fetal Neonatal Med, 2016, 29(18):2915-2923. DOI:10.3109/14767058.2015.1112372. PMID:26512976.
