Can we predict birth asphyxia of neonates born from PPROM women?

Abstract

Background: To develop a simple and accurate method of predicting birth asphyxia of neonates born from preterm premature rupture of membranes (PPROM) women utilizing clinical parameters that are generally available before delivery in the practical setting.Methods: A retrospective cohort was conducted at single tertiary hospital in Jakarta between January and December 2013. Subjects were PPROM women with singleton live pregnancy who had their delivery on 24 to 34 weeks of gestational age (GA). Primary outcome was birth asphyxia defined by 5th minutes APGAR score < 7. The variables studied were leukocyte counts, gestational age at PPROM, clinical chorioamnitis, severe preeclampsia, mode of delivery, and PPROM-admission duration. Prediction model was developed using logistic regression analysis.Results: One hundred and seventy five out of 380 PPROM women registered in our database met the inclusion criteria. The incidence of BA was 14.29% (25/175). The cutoff value for maternal leukocyte counts and gestational age to predict birth asphyxia was respectively 12,450/mm3 (area under the curve 0.68, 95%CI 0.57-0.80) and 32 weeks (area under the curve 0.81, 95%CI 0.70-0.92). A prediction model was developed consisted of GA at PPROM < 32 weeks of GA (OR=9.58, 95%CI 3.32 – 27.62) and maternal leukocyte counts > 12,450/mm3 (OR=3.6, 95%CI 1.11-11.63), (Final AUC=0.82 (95%CI 0.74-0.89). Clinical chorioamnitis, severe preeclampsia, mode of delivery, PPROM-admission duration was not associated with birth asphyxia.Conclusions: A prediction model to predict BA among PPROM women at 24-34 weeks GA was developed consisted of GA at PPROM and maternal leukocyte counts at patient’s admission.