Premature rupture of the membranes (PROM), the risk of infection, and infants' prognosis - two regions compared

The question to be answered was: Does premature rupure of membranes (PROM) and duration of FROM lead to increased mortality, neonatal and late morbidi ty and adverse cognitive developmental outcome? We present data of a bi-nat ional cohort observation study in South Bavaria (SBy) and South Finland (SF ). The sample included all children, who were admitted to a children's hosp ital (SBy N: 7505/70600 live births; SF N: 1536/15618), and some not transf erred control infants (916 and 658, respectively). Obstetric details like F ROM were obtained from perinatal records. Mortality and neonatal morbidity were recorded prospectively. Somatic, neurological and cognitive developmen t was assessed at five and 20 months (corrected age), and final diagnosis o f cerebral palsy (CP) and severe mental retardation was made at 56 months o f age. Data were analysed separately for three gestional groups (<32 (I), 32-36 (I I), and >36 weeks PMA (III)). FROM occurred more frequent in SBy than in SF and in both areas with preterm delivery. FROM irrespective of its duration had no adverse effect on mortality, morbidity, CP-rate or cognitive outcom e of groups I and III in either SBy or SF. There was even a slightly lower mortality rate in extremely preterm infants after FROM. In SBy only, group II with FROM >24 hours had a slightly increased incidence of CP. Unfavorabl e outcome was closely related to perinatal infections, which increased with duration of FROM. FROM and/or preterm labor occurred more often without th an with inflammations of amnion and placenta. We conclude: FROM per se has no adverse effects on longterm outcome of spec ial care infants, but it is closely associated with the developmental risk factors perinatal infections and, in particular, preterm birth. The prevent ion of ascending infections deserves further investigation, although such a ction may be beneficial lately to only a minority of individuals.