Contemporary neonatal outcome following rupture of membranes prior to 25 weeks with prolonged oligohydramnios

Williams, Olivia; Hutchings, Graham J.; Debiève, Frédéric; Debauche, Christian

doi:10.1016/j.earlhumdev.2008.11.003

Cited by 51 publications

(35 citation statements)

References 16 publications

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“…Enfermedad de membrana hialina, neonato con distrés respiratorio, requerimientos de O2 aumentado, radiología compatible y hallazgos de membranas hialinas en bronquiolos terminales, alvéolos y atelectasias (25). Hipoplasia e inmadurez pulmonar en gestaciones menores de 24 semanas, habitualmente con rotura prematura de membranas de inicio precoz y desarrollo pulmonar en fase canalicular en la autopsia (26). Hemorragia intraventricular (HIV) severa, neonato con hemorragia intraventricular masiva cuadriventricular (grado IV) diagnosticadas por ultrasonografía y corroborado por la autopsia (27).…”

Section: Pacientes Y Métodosunclassified

Mortalidad perinatal en el parto prematuro entre 22 y 34 semanas en un hospital público de Santiago, Chile

et al. 2012

Rev. chil. obstet. ginecol.

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RESUMENObjetivo: Conocer la mortalidad perinatal del parto prematuro y los factores de riesgo asociados, usando los datos perinatales clínicos, los resultados de laboratorio y los hallazgos patológicos del feto, neonato y placenta. Métodos: Estudio retrospectivo, cohorte de 407 nacimientos prematuros, únicos, entre 22.0 y 34.0 semanas de gestación. Se estudiaron las muertes fetales y neonatales hasta los 7 días de vida. Fallecieron 122 niños (64 muertes fetales y 58 neonatales), 78 tuvieron autopsia. Resultados: La mortalidad perinatal fue de 30% (122/407). El 71% (87/122) de las muertes ocurrieron antes de las 30 semanas y el 81% (99/122) en nacidos con peso menor de 1500 gramos. Las principales causas de muerte perinatal según el factor asociado con el parto prematuro fueron: infección bacteriana ascendente (IBA) 41% (50/122), anomalía congénita 20% (24/122) e hipertensión arterial 12% (15/122). Los factores de riesgo de muerte perinatal, identificados mediante análisis de regresión logística, fueron: edad gestacional al parto (p<0,001), anomalía congénita (p<0,001), IBA (p=0,02) e hipertensión arterial (p=0,03). Las principales causas de muerte perinatal fueron: hipoxia (aguda o crónica) 28%, infección congénita 23% (preferentemente neumonía 18%), desprendimiento prematuro de placenta con hipoxia y shock hipovolémico 18%, anomalía congénita 18% y síndrome hipertensivo con hipoxia aguda o crónica 7%. Conclusiones: Entre las 22 y 34 semanas de gestación, el parto prematuro por IBA fue la causa más frecuente de muerte perinatal, la edad gestacional al parto fue el principal factor de riesgo de mortalidad y la hipoxia fue la causa más frecuente de muerte. PALABRAS CLAVE: Mortalidad perinatal, nacimiento prematuro, infección congénita SUMMARY Aim:To determine perinatal mortality of premature birth and the risk factors associated using perinatal clinical data, laboratory results and histopathological fetal, neonatal and placental findings. Methods: Retrospective cohort study of 407 preterm single births at 22.0-34.0 weeks gestation. Fetal and neonatal deaths until 7 days of life were studied. One hundred and twenty two children died (64 fetal deaths and 58 neonatal deaths), 78 had autopsy. Results: Perinatal mortality was 30% (122/407). Of total deaths, 71% (87/122) occurred before 30 weeks gestation and 81% (99/122) occurred in very low birth weight infants (<1500 g). The main causes of perinatal mortality according to associated factors for premature birth were: ascending bacterial infection (ABI) 41% (50/122), congenital anomalies 20% (24/122) and hypertension 12% (15/122).

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Section: Pacientes Y Métodosunclassified

Mortalidad perinatal en el parto prematuro entre 22 y 34 semanas en un hospital público de Santiago, Chile

et al. 2012

Rev. chil. obstet. ginecol.

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“…In this population of premature babies who suffer from pulmonary arterial hypertension, we observed a very rapid and positive response to iNO administration, as described previously by others. (1,11) This demonstrates that at least part of the lung disease is reversible and may reflect that at least part of the disease is due to 'functional hypoplasia' , so-called 'dry lung syndrome' (16) in addition to eventual irreversible pulmonary hypoplasia. Aikio et al (17) demonstrated a transient NO deficiency in the first hours of life in patients born after PPROM and presenting with hypoxic respiratory failure, compared to those born after PPROM without hypoxic respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…PPROM (preterm prelabor rupture of membranes) occurs in 3% of pregnancies (1)(2)(3) and represents one third of preterm deliveries. (2,3) Rupture of membranes before 24 weeks is much less common, affecting 0.4% of pregnancies.…”

Section: Introductionmentioning

confidence: 99%

“…(4) Mortality for this condition has been very high historically: survival was 10 to 30% in the 90's and progressively increased up to 70% in the year 2000. (1) In view of these poor outcomes, some centers are inclined to propose immediate TOP (termination of pregnancy) in cases of very early rupture of membranes, even nowadays. However, in some recent studies, survival rates can be as high as 70 to 90%.…”

Section: Introductionmentioning

confidence: 99%

“…However, in some recent studies, survival rates can be as high as 70 to 90%. (1,(5)(6)(7) In addition to the increased risk of mortality, these neonates are also at risk of several morbidities including hypoxemic respiratory failure, sepsis, limb contractures, potential neonatal asphyxia due to cord compression or placental abruption in addition to the risks of (extreme) prematurity. Hypoxemic respiratory failure is attributable to pulmonary hypoplasia and arterial pulmonary hypertension.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of gestational age at PPROM on the short-term outcome of children born after extreme and prolonged preterm prelabor rupture of membranes in an experienced care center

Hocq¹,

B²,

Bernard³

et al. 2017

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Association of Early Inhaled Nitric Oxide With the Survival of Preterm Neonates With Pulmonary Hypoplasia

Ellsworth

Weaver

et al. 2018

JAMA Pediatr

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IMPORTANCE Pulmonary hypoplasia affects a very small percentage of preterm neonates, but its presence is associated with high rates of mortality. OBJECTIVE To determine whether treatment with inhaled nitric oxide during the first week of life was associated with improved in-hospital survival in a cohort of extremely preterm neonates with pulmonary hypoplasia. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Pediatrix Medical Group's Clinical Data Warehouse, a data set containing information from more than 350 neonatal intensive care units in 35 US states and Puerto Rico. Since inhaled nitric oxide was not randomly prescribed, we used 1-to-1 propensity score matching to reduce the imbalance of measured covariates between the 2 treatment groups. The initial, unmatched cohort included singleton neonates who were born between 22 and 29 weeks' gestation, had a birth weight of 400 g or more, were diagnosed with pulmonary hypoplasia as a cause of their respiratory distress, remained free of major anomalies, and were discharged between January 1, 2000, and December 31, 2014. We defined exposure as the initiation of inhaled nitric oxide on day t in days 0 to 7 of the life of a neonate. Each exposed neonate was matched 1-to-1 to a neonate who had not initiated inhaled nitric oxide on a given day. MAIN OUTCOMES AND MEASURES The primary outcome was mortality defined as death prior to transfer or discharge home. Secondary outcomes were any-stage necrotizing enterocolitis, retinopathy of prematurity requiring treatment, chronic lung disease, and periventricular leukomalacia. RESULTS Among 92 635 neonates in our study sample, we identified 767 (0.8%) with pulmonary hypoplasia who met all study inclusion criteria, of whom 185 (0.2%) were exposed to inhaled nitric oxide. Among 151 matched pairs of exposed and unexposed neonates, we did not identify a significant association between inhaled nitric oxide use and mortality (hazard ratio [HR], 0.79; 95% CI, 0.57-1.11). Subgroup analyses of neonates with and without persistent pulmonary hypertension (PPHN) likewise revealed no significant association between inhaled nitric oxide use and mortality (pulmonary hypoplasia with PPHN: HR, 0.67; 95% CI, 0.45-1.01; pulmonary hypoplasia without PPHN: HR, 1.11; 95% CI, 0.61-2.02), but these findings may have been influenced by ascertainment bias. CONCLUSIONS AND RELEVANCE Early treatment with inhaled nitric oxide is not associated with improved survival among extremely preterm neonates with pulmonary hypoplasia. Clinical trials are warranted to clarify the matter.

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Contemporary neonatal outcome following rupture of membranes prior to 25 weeks with prolonged oligohydramnios

Cited by 51 publications

References 16 publications

Mortalidad perinatal en el parto prematuro entre 22 y 34 semanas en un hospital público de Santiago, Chile

Mortalidad perinatal en el parto prematuro entre 22 y 34 semanas en un hospital público de Santiago, Chile

Impact of gestational age at PPROM on the short-term outcome of children born after extreme and prolonged preterm prelabor rupture of membranes in an experienced care center

Association of Early Inhaled Nitric Oxide With the Survival of Preterm Neonates With Pulmonary Hypoplasia

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