Estimated fetal weight and severe neonatal outcomes in preterm prelabor rupture of membranes

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_jpm-2019-0474_abs_001_w2aab3b7b5b1b6b1aab1c11b2Aa"><jats:title>Objectives</jats:title><jats:p>Our aim was to study the association of clinical variables obtainable before delivery for severe neonatal outcomes (SNO) and develop a clinical tool to calculate the prediction probability of SNO in preterm prelabor rupture of membranes (PPROM).</jats:p></jats:sec><jats:sec id="j_jpm-2019-0474_abs_002_w2aab3b7b5b1b6b1aab1c11b3Aa"><jats:title>Methods</jats:title><jats:p>This was a prospective study from October 2015 to May 2018. We included singleton pregnancies with PPROM and an estimated fetal weight (EFW) two weeks before delivery. We excluded those with fetal anomalies or fetal death. We examined the association between SNO and variables obtainable before delivery such as gestational age (GA) at PPROM, EFW, gender, race, body mass index, chorioamnioitis. SNO was defined as having at least one of the following: respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, neonatal sepsis, or neonatal death. The most parsimonious logistic regression models was constructed using the best subset selection model approach, and receiver operator curves were utilized to evaluate the prognostic accuracy of these clinical variables for SNO.</jats:p></jats:sec><jats:sec id="j_jpm-2019-0474_abs_003_w2aab3b7b5b1b6b1aab1c11b4Aa"><jats:title>Results</jats:title><jats:p>We included 106 pregnancies, 42 had SNO (39.6%). The EFW (area under the receiver operating characteristic curve [AUC]=0.88) and GA at PPROM (AUC=0.83) were significant predictors of SNO. The addition of any of the other variables did not improve the predictive probability of EFW for the prediction of SNO.</jats:p></jats:sec><jats:sec id="j_jpm-2019-0474_abs_004_w2aab3b7b5b1b6b1aab1c11b5Aa"><jats:title>Conclusions</jats:title><jats:p>The EFW had the strongest association with SNO in in our study among variables obtainable before delivery. Other variables had no significant effect on the prediction probability of the EFW. Our findings should be validated in larger studies.</jats:p></jats:sec>

Predicting risk of severe neonatal outcomes in preterm infants born from mother with prelabor rupture of membranes

“…A recent study for prediction of SNO conducted by Jose R. Duncan et al [ 15 ] reported that estimated fetal weight could be used as a clinical toll to calculate the prediction probability of SNO in PPROM. In their model, several variables available before delivery such as gestational age, diabetes mellitus, fetal growth restriction and the appearance of clinical chorioamnionitis et al were enrolled in their model.…”

“…There were several studies developed graphical tools or model to predict survival or survival without severe morbidities in preterm infants [ 12 – 14 ]. To facilitate prediction in PROM pregnancies, Jose R. Ducan et al used clinical variables obtainable before delivery for severe neonatal outcomes and found estimated fetal weight showed significant effect on the prediction probability of the SNO [ 15 ]. Physicians and parents sometimes need to make critical decisions about neonatal care with short- and long-term implications on infant’s health and families.…”

Detection of small for gestational age in preterm prelabor rupture of membranes by Hadlock versus the Fetal Medicine Foundation growth charts

“…In addition, the evaluated adverse neonatal outcomes in our secondary outcomes have been previously validated and are known to cause severe morbidity and mortality in premature infants [37,39]. Lastly, both charts studied were derived from the Hadlock formula, and the same has been validated in our PPROM population [36], and the EFW in this population has been shown to be a significant predictor of adverse perinatal outcomes [40].…”