Neonatal complications of preterm premature rupture of membranes: Pathophysiology and management

Characteristics of pulmonary hypertension in preterm neonates

“…Preterm infants with hypoplastic lungs may have elevated pulmonary vascular resistance 16,17 and this may be related to maldevelopment including a decrease in the cross-sectional area and an abnormal muscularization of the pulmonary vasculature. 18 In a large prospective cohort study of rupture of membranes (ROM) at 15 to 28 weeks' gestation, GA at the time of ROM, latency period and amniotic fluid index were important independent predictors of neonatal pulmonary hypoplasia and perinatal death. 19 Infants born with PPROM are at increased risk of respiratory distress secondary to pulmonary hypoplasia and pneumonia.…”

Mortality Risk Associated with Perinatal Drug and Alcohol Use in California

“…[3][4][5][6][7] These health outcomes, by themselves, have been associated with increased morbidity and mortality. [8][9][10][11][12] Although mortality is only one measure of the health of pregnant women and their infants, it represents an important indicator. A national priority has been established to reduce maternal and infant mortality, as described in the Healthy People 2010 objectives.…”

Strategies of Cardiovascular and Ventilatory Management in Preterm Infants With Prolonged Rupture of Fetal Membranes and Oligohydramnios

“…We have recently reported similar experience with infants having sublethal pulmonary hypoplasia following preterm premature rupture of membranes (PPROM) and oligohydramnios occurring as early as 14 weeks' gestation. 2 Six of eight cases were treated with nitric oxide and four survived, each with an immediate response similar to that described in the cases of Geary and Whitsett. Although, these infants had been exposed to severe oligohydramnios, in at least two of the four cases, there was ongoing vaginal fluid leaking, suggesting continued fetal fluid production.…”

“…Although, these infants had been exposed to severe oligohydramnios, in at least two of the four cases, there was ongoing vaginal fluid leaking, suggesting continued fetal fluid production. Our experience has suggested even small amounts of fluid may modulate the degree of pulmonary hypoplasia 2,3 With current technology, some infants may survive now who would not have in the past decade. 2 The clinical presentation of pulmonary hypertension with secondary hypoxemia in these cases is consistent with postmortem histopathologic findings of markedly increased alveolar ductal artery muscularization.…”

“…Our experience has suggested even small amounts of fluid may modulate the degree of pulmonary hypoplasia 2,3 With current technology, some infants may survive now who would not have in the past decade. 2 The clinical presentation of pulmonary hypertension with secondary hypoxemia in these cases is consistent with postmortem histopathologic findings of markedly increased alveolar ductal artery muscularization. 4 Another lung structural change that may be an important determinant of clinical outcome relates to elastic tissue, which is severely diminished in infants with PPROM.…”