Outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks of gestation

Objective: To identify factors influencing the outcome of premature infants delivered after prolonged premature rupture of membranes before 25 weeks' gestation. Design and population: All premature infants with gestational ag e <34 weeks, either inborn or outborn, with history of rupture of membranes before 25 weeks' gestation, admitted to our NICU between January 1992 and July 1997, were eligible for this retrospective study. Collected informatio n included birth weight, gestational age at rupture of membranes and at del ivery, duration between rupture of membranes and delivery (latency period), severity of oligohydramnios, pre- and post-natal managements, and follow-u p of survivors. Results: A total of 28 neonates fulfilled the inclusion cri teria. Despite new strategies of ventilation and optimal management, the ov erall mortality rate was 43% (12/28). Nonsurvivors were significantly less mature at rupture of membranes, and had severe oligohydramnios (anamnios). We also noted less antenatal corticosteroids and antibiotic therapy in this group. Nine of eleven infants (82%) following rupture of membranes before 22 weeks' gestation died shortly after birth. The two remaining infants dev eloped severe bronchopulmonary dysplasia. Nine deaths occurred in thirteen cases (69%) of anamnios. The major death causes were refractory respiratory failure and neurologic complications. Half of all survivors (8/16) develop ed bronchopulmonary dysplasia. Conclusion: The outcome of premature infants following prolonged premature rupture of membranes before 25 weeks' gestat ion is influenced by gestational age at rupture, severity of oligohydramnio s, and antenatal antibiotics and corticosteroids. Neonates with rupture of membranes before 22 weeks have a very low chance of survival at the present time. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.