Premature Rupture of Membranes: How Does It Affect Neonatal Outcomes in Premature Infants?

Öz

Aim: Premature rupture of membranes (PROM) can cause preterm birth, neonatal morbidity and mortality. In this study, we aim to examine the effect of PROM on the early prognosis of premature infants <30 weeks, provide a basis for the management of premature infants and prenatal consultation. Materials and Method:710 premature infants with a gestational age of 240-296 weeks who were followed up in a tertiary neonatal intensive care unit between 2014-2018 were retrospectively evaluated. According to the presence of PROM, infants were divided into two groups: PROM group (n = 147) and no-PROM group (n = 563). Maternal and neonatal data were analyzed. Results:In the study, the median (min-max) gestational age (GA) was 27 weeks (24-29) in PROM group, and 28 weeks (25-29) in no-PROM group (p <0.001).The median (min-max) PROM duration was 115 (18-850) hours. Histological chorioamnionitis, the number of babies <28 weeks and early neonatal sepsis were higher in PROM group compared to no-PROM group (p<0.001). Conclusion: PROM may cause poor fetal and neonatal outcomes by increasing the risk of chorioamnionitis and preterm labor. It has been thought that with appropriate follow-up and treatment of pregnant women with PROM in terms of the development of chorioamnionitis, preterm birth and development of neonatal infection might be prevented.

Anahtar Kelimeler

• Preterm premature rupture of membranes
• prematurite
• prognosis

Erken Membran Rüptürü: Prematüre Bebeklerde Neonatal Sonuçları Nasıl Etkiler?

Öz

Amaç: Erken membran rüptürü (EMR) preterm doğuma, neonatal morbiditelere ve mortaliteye sebep olabilir. Bu çalışmadaki amacımız EMR’nin <30 hafta prematüre bebeklerin erken prognozu üzerindeki etkisini incelemek, prematüre bebeklerin yönetimi ve prenatal konsültasyon için bir temel sağlamaktır. Gereçler ve Yöntem: 2014-2018 yıllarında, gebelik yaşı 240-296 hafta arasında olan ve üçüncü düzey bir yenidoğan yoğun bakım ünitesinde izlenen toplam 710 prematüre bebek retrospektif olarak değerlendirildi. Hastalar EMR varlığına veya yokluğuna göre EMR grubu (n = 147) ve EMR olmayan grup (n =563) olarak iki gruba ayrıldı. Maternal ve neonatal veriler analiz edildi. Bulgular: Çalışmaya dahil edilen bebeklerden EMR olan grupta median (min-maks) gebelik haftası (GH) 27 hafta (24-29), EMR olmayan grupta 28 hafta (25-29) (p<0.001) idi. EMR süresinin median değeri (min-maks) 115 saat (18-850) olarak saptandı. EMR olmayan grupla karşılaştırıldığında, EMR olan grupta histolojik koryoamniyonit, <28 hafta olan bebek sayısı ve erken neonatal sepsis daha yüksek oranda tespit edildi (p<0.001). Sonuç: EMR, koryoamniyonit ve preterm doğum riskini arttırarak kötü fetal-neonatal sonuçlara sebep olabilir. EMR’li gebelere koryoamniyonit gelişimi açısından uygulanacak uygun takip ve tedavi ile preterm doğum ve neonatal enfeksiyon gelişiminin önlenebileceği düşünüldü.

Anahtar Kelimeler

• Erken membran rüptürü
• prematürite
• prognoz

Kaynakça

1. Mercer BM. Preterm prematüre rupture of the membranes. Obstet Gynecol 2003; 101:178-93.
2. Mercer BM. Preterm prematüre rupture of the membranes: Current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32: 411–28.
3. Pasquier JC, Rabilloud M, Picaud JC, Ecochard R, Claris O, Gaucherand P, et al. A prospective population-based study of 598 cases of PPROM between 24 and 34 weeks gestation: description, management, and mortality (DOMINOS cohort). Eur J Obstet Gynecol 2005;121:164-70.
4. Everest NJ, Jacobs SE, Davis PG, Begg L, Rogerson S. Outcomes following prolonged preterm premature rupture of the membranes. Arch Dis Child Fetal Neonatal Ed 2008;93: 207-11.
5. Williams O, Hutchings G, Hubinont C, Debauche C, Greenough A. Pulmonary effects of prolonged oligohydramnios following mid-trimester rupture of the membranes-antenatal and postnatal management. Neonatology 2012; 101: 83-90.
6. Strunk T, Doherty D, Jacques A, Simmer K, Richmond P, Kohan R, et al. Histologic chorioamnionitis is associated with reduced risk of late-onset sepsis in preterm Infants. Pediatrics 2012; 129:134-41.
7. Thomas W, Speer CP. Chorioamnionitis: important risk factor or innocent by stander for neonatal outcome. Neonatology 2011; 99: 177-87.
8. Hutzal CE, Boyle EM, Kenyon SL, Nash JV, Winsor S, Taylor DJ, et al. Use of antibiotics for the treatment of preterm parturition and prevention of neonatal morbidity: a metaanalysis. Am J Obstet Gynecol 2008;199:620.e1-8.

9. Haque KN. Definitions of bloodstream infection in the newborn. Pediatr Crit Care Med 2005; 6: 45-49.
10. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Care Med 2001; 163: 1723-729.
11. Ofman G, Vasco N, Cantey JB. Risk of early-onset sepsis following preterm, prolonged rupture of membranes with or without chorioamnionitis. Am J Perinatol. doi:10.1055/S-0035-1556758.
12. Ylijoki M, Ekholm E, Haataja L, Lehtonen L; PIPARI study group. Is chorioamnionitis harmful for the brain of preterm infants? Acta Obstet Gynecol Scand 2012; 91: 403-19.
13. Manuck TA, Maclean CC, Silver RM, Varner MW. Preterm premature rupture of membranes: does the duration of latency influence perinatal outcomes? Am J Obstet Gynecol 2009; 201: 414.e1-6.
14. Ahn HM, Park EA, Cho SJ, Kim YJ, Park HS. The association of histological chorioamnionitis and antenatal steroids on neonatal outcome in preterm infants born at less than thirty-four weeks’ gestation. Neonatology 2012; 102: 259-64.
15. Han X, Du H, Cao Y, Zhang J, Zhang L, Li Z et al. Association of histological and clinical chorioamnionitis with perinatal and neonatal outcome. J Matern Fetal Neonatal Med. Doi:10.1080/14767058.2019.1618824.
16. Zhang S, Chen XY, Chen C, Qiu XM, Lin BC, Yang CZ. Influence of premature rupture of membranes on the early prognosis of extremely premature infants. Doi: 10.7499/1008-8830.2009141.
17. Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Goldberg R, et al. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002 2003. Pediatr Infect Dis J 2005; 24: 635-39.
18. Klinger G, Levy I, Sirota L, Boyko V, Reichman B, Geva LL. Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants. Am J Obstet Gynecol 2009; 201: 38, e1-6.
19. Martius JA, Roos T, Gora B, Oehler MK, Schrod L, Papadopoulos T, et al. Risk factors associated with early-onset sepsis in premature infants. Euorop J Obst Gynec Repro Bio 85: 1999; 151-58.
20. Tita ANT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 2010; 37: 339-54.
21. Lin F, Dong H, Song Y, Zhang T, Qi J, Xiao X, Cai Y. Effect of bronchopulmonary dysplasia on the early intellectual development of preterm infants. Pediatr Int 2017; 59: 691-97.
22. Hanke K, Hartz A, Manz M, Bendiks M, Heitmann F, Orlikowsky T. Preterm Prelabor Rupture of Membranes and Outcome of Very-Low-Birth-Weight Infants in the German Neonatal Network. PLoS One. 2015; 10 :e0122564.
23. Wolfs TGAM, Jellema RK, Turrisi G,3, Becucci E, Buonocore G, Kramer BW. Inflammation-induced immune suppression of the fetus: a potential link between chorioamnionitis and postnatal early onset sepsis. J Matern Fetal Neonatal Med 2012; 25 : 8-11.
24. Watterberg KL, Demers LM, Scott SM, Murphy S. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 1996; 97: 210-15.
25. Randis TM, Rice MM, Myatt L, Tita TNA, Leveno KJ, Reddy UM et al. Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis. J Perinat Med. 2018; 46: 926-33. doi:10.1515/jpm-2017-0192.
26. Lorthe E, Ancel PY, Torchin H, Kaminski M, Langer B, Subtil D, 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 Pediatr 2017; 182: 47-52.