PROLONGED RUPTURE OF MEMBRANES IN THE TERM NEWBORN

Of 8791 consecutive newborns, we studied 205 (2.3%) women with a histo ry of prolonged rupture of membranes (FROM) greater than 24 hr to asse ss the incidence of infection, to identify the rate of clinical sympto ms, and to examine the use of the white blood count (WBC) and neutroph il values as screening tools to predict infection. Blood culture and c omplete blood counts (CBC) were obtained in 175 (85%). Fifteen (8.2%) had positive blood cultures including group B streptococcus, streptoco ccus viridans, streptococcus pneumoniae, staphlococcus epidermidis, an d staphlococcus aureus. In the remaining 8586 infants born to mothers without FROM, 10 had positive blood cultures for an incidence of 0.1%. In the FROM group, the six who manifested clinical symptoms had abnor mal CBCs; abnormal white blood count (2), abnormal neutrophil count (5 ), high band/metatamyelocyte count (4), and increased immature to tota l neutrophil ratio (4). Of the nine asymptomatic infants, seven (78%) had abnormal CBCs, five (56%) with a high WBC, five (56%) had a high n eutrophil count, two (22%) had a high band/metatamyelocyte count, and one a high immature to total neutrophil ratio. CBC values were obtaine d from infants with FROM and negative blood cultures. Five of these 15 controls had an abnormal CBC. In the term newborn, FROM is associated with significantly increased incidence of positive blood cultures. Th e sensitivity of the CBC was 86% and specificity 66%. In view of this data a conservative clinical approach utilizing blood cultures and CBC evaluations in the management of FROM is warranted.