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Preterm bebeklerde erken membran rüptürünün mortalite ve morbiditeye etkisi

Year 2005, Volume: 36 Issue: 4, 179 - 183, 01.05.2005

Emel Altuncu Sultan Kavuncuoğlu Zeynel Albayrak Esin Yıldız Aldemir Diğdem Bezen

Abstract

Objective: The incidence of neonatal infection after premature rupture of membranes (PROM) more than 24 hours is approximately 1% and it increases to 4% in preterm premature rupture of membranes (P-PROM). This study was conducted to evaluate the effects of P-PROM on the incidence of sepsis and mortality. Materials and Methods: 191 preterm babies with P-PROM of more than 18 hours were evaluated between January 2000 to December 2001. A gestational age-matched patient admitted on the same day to our neonatal care unit without PPROM was enrolled to control group for every study group infant. The diagnosis of sepsis was based on clinical assessment, infection markers and culture results of patients. The mortality and morbidity of the P-PROM and control group were compared. Results: Of 2060 preterm babies, 191 had P-PROM. In P-PROM group, 52% of babies were female, 48% were male and, female and male rates were 50% in the control group. Abdominal delivery was seen in 60% of P-PROM group and 54% in controls. No significant difference regarding the rates of birth weight, sex, route of delivery and asphyxia of patients were identified. The range of duration of the PROM was changed from 18 hours to 53 days and there was not seen any significant relation between PROM duration and sepsis. The rate of early onset sepsis was 5.2% in P-PROM group and 2.1% in control group. P-PROM had a significant relation to early onset sepsis in preterm infants and it was associated with lower incidences of transient tachypnea of newborn and respiratory distress syndrome but, had no effect on incidence of necrotising enterocolitis. Conclusion: P-PROM is an important risk factor in aetiology of early onset sepsis in preterm babies. Identification and close follow up of the risk factors are needed to decrease the morbidity and mortality.

Keywords

Premature Birth Mortality Morbidity Fetal Membranes Premature Rupture Sepsis

References

  • 1.Newton ER. Preterm labor, preterm rupture of membranes and chorioamnionitis.Clin Perinatol 2005;32:571-600
  • 2. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Baron L et al. Neonatal necrotizing enterocolitis:Theuropatic decision based upon clinical staging. Ann Surg 1978;187:l-7
  • 3.Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage:a study of infants with birth weights less than 1500 grams. J Pediatr 1978;92:529-534
  • 4.Mercer BM. Preterm premature rupture of membranes: current approach to evaluation and management. Obstet Gynecol Clin N Am 2005; 32:411-428. , 5.Gerdes JS. Clinicopathologic approach to the diagnosis of neonatal sepsis. Clin Perinatol 1991;18;361-379
  • 6.Dağoğlu T. Neonatoloji: Yenidoğanm enfeksiyonları
  • İstanbul:Nobel Tıp Kitabevleri, 2000:679-708
  • 7.Linder N, Ohel G, Gazit G, Keidar D, Tamir I, Reichman B. Neonatal sepsis after prolonged premature rupture of membranes. J Perinatol 1995 Jan-Feb;15(1):36-38
  • 8.Nicaise C, Gire C, Fagianelli P, Debriere R, Thomachot L, d'Ercole C, Boubli L. Neonatal consequences of preterm premature rupture of membrane (PPROM) at 24-34 WG: 118 singleton pregnancies. J Gynecol Obstet Biol Reprod (Paris) 2002 Dec;31(8):747-754
  • 9.Joachin Roy H, Flores Nava G. Development of high risk infants following premature membrane rupture in a neonatal intensive care unit. Ginecol Obstet Mex 1995 Mar;63:119-122
  • 10.Asindi AA, Archibong El, Mannan NB. Motherinfant colonization and neonatal sepsis in prelabor rupture of membranes. Saudi Med J 2002 Oct;23(10):1270-1274
  • 11.Elci S, Gül K, Akpolat NO, Göçmen A. Gebe kadınlarda Grup B streptokok kolonizasyonu
  • KLİMİK Dergisi 1997; 10(2): 76-77
  • 12.Ceran N, Göktaş P, Ceran Ö, Güven H. Gebe kadınlar ve yenidoğan bebeklerinde, Grup B Streptokok taşıyıcılığı. Mikrobiyoloji Bülteni 1999;33(l):21-27
  • 13.Beydoun SN, Yasin SY. Premature rupture of the membranes before 28 weeks: conservative management. Am J Obstet Gynecol 1986;155:471-479
  • 14.Fanaroff AA, Wright LL, Stevenson DK, Shankaran S, Donovan EF, Ehrenkranz RA, et al
  • Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992. Am J Obstet Gynecol 1995; 173:1423-1431
  • 15.Hallak M, Bottoms SF. Accelerated pulmonary maturation from preterm premature rupture of membranes. A myth. Am J Obstet Gynecol 1993;169:1045-1049
  • 16.Berkowitz RL, Kantor RD, Beck GJ, Warshaw JB. The relation between premature rupture of membranes and the respiratory distress syndrome; an update and plan of management. Am J Obstet Gynecol 1978;131:503-508
  • 17.Schucker JL, Mercer BM. Midtrimester premature rupture of the membranes. Semin Perinatol 1996;20:389-400
  • 18.Oshiro BT, Monga M, Blanco JD. Intraamniotic infections. Semin Perinatol 1993;17:420-425
  • 19.Seaward GR, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE et al. International multicenter term PROM study: Evolution of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Am J Obstet Gynecol 1998;179:635-639

The effect of premature rupture of membranes to the morbidity and mortality of preterm babies

Year 2005, Volume: 36 Issue: 4, 179 - 183, 01.05.2005

Emel Altuncu Sultan Kavuncuoğlu Zeynel Albayrak Esin Yıldız Aldemir Diğdem Bezen

Abstract

Amaç: Erken membran rüptürünün (EMR) 24 saati geçtiği durumlarda neonatal enfeksiyon insidansı term bebeklerde yaklaşık %1'dir ve bu oran pretermlerde 4 kat artmaktadır. Bu çalışma; preterm EMR'li bebeklerde sepsis görülme sıklığı ve mortaliteye etkisini araştırmak için planlandı. Gereç ve Yöntem : Hastanemizde Ocak 2000-Aralık 2001 tarihleri arasında doğan preterm bebeklerden annesinde 18 saatten uzun süreli membran rüptürü olan 191 preterm bebek incelendi. Preterm EMR'li olgulardan sonra servise ilk interne edilen, EMR'li olgu ile aynı gestasyon hafta grubuna giren, EMR'si olmayan preterm bebekler kontrol grubunu oluşturdu. Tüm bebeklerin enfeksiyon markerları (C-reaktif protein, lökosit ve trombosit düzeyleri, band/PNL oranı mikrosedimentasyon) çalışıldı ve sepsis tanısı klinik bulgular, kültür sonuçları ve enfeksiyon markerları değerlendirilerek kondu. EMR'li preterm bebekler, kontrol grubu ile mortalite ve morbidite açısından karşılaştırıldı Bulgular: Yenidoğan ünitesine yatırılan 2060 preterm bebeğin 191'inde EMR saptandı. Bu bebeklerin %52'si kız, %48'i erkek, kontrol grubundaki bebeklerin %50'si kız, %50'si erkek idi. EMR'li bebeklerin % 60'ı, kontrol grubundaki bebeklerin %54'ü sezaryenle doğurtuldu. İki grup arasında cinsiyet, doğum ağırlığı, doğum şekli, asfiksi varlığı açısından fark bulunmadı. EMR süresi 18 saat ile 53 gün arasında değişiyordu. Sepsis ile EMR süresi arasında anlamlı bir ilişki görülmedi. Erken sepsis hızı EMR'li grupta %5.2, kontrol grubunda %2.1 bulundu. EMR varlığı ile erken sepsis gelişimi arasındaki ilişki anlamlı idi. Yenidoğanın geçici takipnesi ve respiratuar distres sendromu görülme sıklığı kontrol grubunda fazla iken, nekrotizan enterokolit insidansı açısından fark saptanmadı. Sonuç: EMR, preterm bebeklerde erken sepsis için önemli bir risk faktörüdür. Mortalite ve morbiditeyi azaltmak için risk faktörlerinin belirlenerek hastaların yakından izlemi gerekmektedir.

Keywords

Prematüre doğum Ölüm oranı Hastalık oranı Fetal membranlar prematür rüptür Sepsis

References

  • 1.Newton ER. Preterm labor, preterm rupture of membranes and chorioamnionitis.Clin Perinatol 2005;32:571-600
  • 2. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Baron L et al. Neonatal necrotizing enterocolitis:Theuropatic decision based upon clinical staging. Ann Surg 1978;187:l-7
  • 3.Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage:a study of infants with birth weights less than 1500 grams. J Pediatr 1978;92:529-534
  • 4.Mercer BM. Preterm premature rupture of membranes: current approach to evaluation and management. Obstet Gynecol Clin N Am 2005; 32:411-428. , 5.Gerdes JS. Clinicopathologic approach to the diagnosis of neonatal sepsis. Clin Perinatol 1991;18;361-379
  • 6.Dağoğlu T. Neonatoloji: Yenidoğanm enfeksiyonları
  • İstanbul:Nobel Tıp Kitabevleri, 2000:679-708
  • 7.Linder N, Ohel G, Gazit G, Keidar D, Tamir I, Reichman B. Neonatal sepsis after prolonged premature rupture of membranes. J Perinatol 1995 Jan-Feb;15(1):36-38
  • 8.Nicaise C, Gire C, Fagianelli P, Debriere R, Thomachot L, d'Ercole C, Boubli L. Neonatal consequences of preterm premature rupture of membrane (PPROM) at 24-34 WG: 118 singleton pregnancies. J Gynecol Obstet Biol Reprod (Paris) 2002 Dec;31(8):747-754
  • 9.Joachin Roy H, Flores Nava G. Development of high risk infants following premature membrane rupture in a neonatal intensive care unit. Ginecol Obstet Mex 1995 Mar;63:119-122
  • 10.Asindi AA, Archibong El, Mannan NB. Motherinfant colonization and neonatal sepsis in prelabor rupture of membranes. Saudi Med J 2002 Oct;23(10):1270-1274
  • 11.Elci S, Gül K, Akpolat NO, Göçmen A. Gebe kadınlarda Grup B streptokok kolonizasyonu
  • KLİMİK Dergisi 1997; 10(2): 76-77
  • 12.Ceran N, Göktaş P, Ceran Ö, Güven H. Gebe kadınlar ve yenidoğan bebeklerinde, Grup B Streptokok taşıyıcılığı. Mikrobiyoloji Bülteni 1999;33(l):21-27
  • 13.Beydoun SN, Yasin SY. Premature rupture of the membranes before 28 weeks: conservative management. Am J Obstet Gynecol 1986;155:471-479
  • 14.Fanaroff AA, Wright LL, Stevenson DK, Shankaran S, Donovan EF, Ehrenkranz RA, et al
  • Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992. Am J Obstet Gynecol 1995; 173:1423-1431
  • 15.Hallak M, Bottoms SF. Accelerated pulmonary maturation from preterm premature rupture of membranes. A myth. Am J Obstet Gynecol 1993;169:1045-1049
  • 16.Berkowitz RL, Kantor RD, Beck GJ, Warshaw JB. The relation between premature rupture of membranes and the respiratory distress syndrome; an update and plan of management. Am J Obstet Gynecol 1978;131:503-508
  • 17.Schucker JL, Mercer BM. Midtrimester premature rupture of the membranes. Semin Perinatol 1996;20:389-400
  • 18.Oshiro BT, Monga M, Blanco JD. Intraamniotic infections. Semin Perinatol 1993;17:420-425
  • 19.Seaward GR, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE et al. International multicenter term PROM study: Evolution of predictors of neonatal infection in infants born to patients with premature rupture of membranes at term. Am J Obstet Gynecol 1998;179:635-639
There are 21 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Emel Altuncu This is me

Sultan Kavuncuoğlu This is me

Zeynel Albayrak This is me

Esin Yıldız Aldemir This is me

Diğdem Bezen This is me

Publication Date May 1, 2005
Published in Issue Year 2005 Volume: 36 Issue: 4

Cite

APA Altuncu, E., Kavuncuoğlu, S., Albayrak, Z., Aldemir, E. Y., et al. (2005). The effect of premature rupture of membranes to the morbidity and mortality of preterm babies. Zeynep Kamil Tıp Bülteni, 36(4), 179-183. https://doi.org/10.16948/zktb.20490
AMA Altuncu E, Kavuncuoğlu S, Albayrak Z, Aldemir EY, Bezen D. The effect of premature rupture of membranes to the morbidity and mortality of preterm babies. Zeynep Kamil Tıp Bülteni. May 2005;36(4):179-183. doi:10.16948/zktb.20490
Chicago Altuncu, Emel, Sultan Kavuncuoğlu, Zeynel Albayrak, Esin Yıldız Aldemir, and Diğdem Bezen. “The Effect of Premature Rupture of Membranes to the Morbidity and Mortality of Preterm Babies”. Zeynep Kamil Tıp Bülteni 36, no. 4 (May 2005): 179-83. https://doi.org/10.16948/zktb.20490.
EndNote Altuncu E, Kavuncuoğlu S, Albayrak Z, Aldemir EY, Bezen D (May 1, 2005) The effect of premature rupture of membranes to the morbidity and mortality of preterm babies. Zeynep Kamil Tıp Bülteni 36 4 179–183.
IEEE E. Altuncu, S. Kavuncuoğlu, Z. Albayrak, E. Y. Aldemir, and D. Bezen, “The effect of premature rupture of membranes to the morbidity and mortality of preterm babies”, Zeynep Kamil Tıp Bülteni, vol. 36, no. 4, pp. 179–183, 2005, doi: 10.16948/zktb.20490.
ISNAD Altuncu, Emel et al. “The Effect of Premature Rupture of Membranes to the Morbidity and Mortality of Preterm Babies”. Zeynep Kamil Tıp Bülteni 36/4 (May 2005), 179-183. https://doi.org/10.16948/zktb.20490.
JAMA Altuncu E, Kavuncuoğlu S, Albayrak Z, Aldemir EY, Bezen D. The effect of premature rupture of membranes to the morbidity and mortality of preterm babies. Zeynep Kamil Tıp Bülteni. 2005;36:179–183.
MLA Altuncu, Emel et al. “The Effect of Premature Rupture of Membranes to the Morbidity and Mortality of Preterm Babies”. Zeynep Kamil Tıp Bülteni, vol. 36, no. 4, 2005, pp. 179-83, doi:10.16948/zktb.20490.
Vancouver Altuncu E, Kavuncuoğlu S, Albayrak Z, Aldemir EY, Bezen D. The effect of premature rupture of membranes to the morbidity and mortality of preterm babies. Zeynep Kamil Tıp Bülteni. 2005;36(4):179-83.