Neonatal outcomes and risk of neonatal sepsis in an expectantly managed cohort of late preterm prelabor rupture of membranes

Chiossi, Giuseppe; Tommaso, Mariarosaria Di; Monari, Francesca; Consonni, Sara; Strambi, Noemi; Zoccoli, Sofia Gambigliani; Seravalli, Viola; Comerio, Chiara; Betti, Marta; Cappello, Anna; Vergani, Patrizia; Facchinetti, Fabio; Locatelli, Anna

doi:10.1016/j.ejogrb.2021.03.036

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…Furthermore, use of antibiotics did not influence the rate of cesarean delivery or affect the maternal outcomes examined. The 0.53% to 1.1% incidence of neonatal sepsis detected in our cohort was similar to the 0.8 reported during 2021 by Chiossi et al, 21 and was relatively lower than reported in previous trials. [18][19][20] The incidence of neonatal sepsis reported during 2012 was nearly 4% and during 2016 it was 2%.…”

Section: Discussionsupporting

confidence: 91%

“…Several studies support the practice of expectant management in pregnant women with ruptured membranes between 34 0/7 and 36 6/7 weeks of gestation, in the absence of contraindications to extending pregnancy. [18][19][20][21] The findings of those studies have indicated that immediate birth does not decrease neonatal sepsis, yet increases the probability of neonatal respiratory distress and mechanical ventilator support, as well as cesarean delivery. 18,22 In contrast to the present study, in which groups (centers) were divided according to latency antibiotic use, in previous randomized trials that compared expectant management with induction of labor at admission in women with ROM at 34 0/7 to 36 6/7 weeks' gestation, latency antibiotics were not part of the randomization; therefore, the effects of antibiotic use were not examined.…”

Section: Discussionmentioning

confidence: 99%

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Perinatal Outcomes of Late Preterm Rupture of Membranes with or without Latency Antibiotics

Abu Nofal,

Massalha,

Diab

et al. 2024

Am J Perinatol

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Objective To examine whether the addition of latency antibiotics in late preterm rupture of membranes (ROM) decreases neonatal infection and increases latency. Study Design This retrospective two-center study was conducted at Holy Family Hospital (HFH) in Nazareth and Emek Medical Center (EMC) in Afula, on data collected between January 2017 and April 2023. HFH is the smaller institution. EMC and HFH implement similar policies regarding ROM at 34 0/7 to 36 6/7 weeks’ gestation; the only difference is that a 10-day course of latency antibiotics is implemented at EMC. All women with ROM between 34 0/7 and 36 6/7 weeks’ gestation who were admitted to one of the centers during the study period, and had a live fetus without major malformations, were included. The primary outcome was neonatal sepsis rate. Secondary outcomes included a composite of neonatal sepsis, mechanical ventilation ≥24 h, and perinatal death. Additionally, gestational age at delivery and delivery mode were examined. Results Overall, 721 neonates were delivered during the study period: 534 at EMC (where latency antibiotics were administered) and 187 at HFH. The gestational age at ROM was similar (35.8 and 35.9 weeks, respectively, p=0.14). Neonatal sepsis occurred in six (1.1%) neonates at EMC and one (0.5%) neonate at HFH (adjusted p=0.71; OR: 1.69; 95% CI: 0.11–27.14). The composite secondary outcome occurred in nine (1.7%) and three (1.6%) neonates at EMC and HFH, respectively (adjusted p=0.71; OR: 0.73; 95% CI: 0.14–3.83). The gestational age at delivery was 36.1 and 36.2 weeks at EMC and HFH, respectively (mean difference: 5 hours; adjusted p=0.02). The cesarean delivery rate was 24.7% and 19.3% at EMC and HFH, respectively (adjusted p=0.96). Conclusions Latency antibiotics administered to women admitted with ROM between 34 0/7 and 36 6/7 weeks’ gestation did not decrease the rate of neonatal sepsis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Perinatal Outcomes of Late Preterm Rupture of Membranes with or without Latency Antibiotics

Abu Nofal,

Massalha,

Diab

et al. 2024

Am J Perinatol

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“…9 Among all births, there are approximately 3% to 6% born with late preterm gestations ranging between 34 and 36 weeks. 11 For neonates born with PROM and presenting symptoms suggestive of sepsis, hospitalization with empirical antibiotic use is generally agreed upon. However, the management of the overall well-being of neonates born with PROM remains puzzling.…”

Section: Introductionmentioning

confidence: 99%

“…9 Among all births, there are approximately 3% to 6% born with late preterm gestations ranging between 34 and 36 weeks. 11…”

Section: Introductionmentioning

confidence: 99%

The impact of premature rupture of membrane on neonatal outcomes in infants born at 34 weeks gestation or later

Su,

Chen,

Tsao

et al. 2024

Journal of the Chinese Medical Association

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Background: Premature rupture of membranes (PROMs) is a known risk for adverse neonatal outcomes, often leading to neonatal hospitalization due to suspected perinatal infection or other issues. This study assesses PROM’s clinical impact on neonatal outcomes in infants born at 34 weeks of gestation or later. Methods: We studied hospitalized neonates born between December 2018 and November 2019, with gestational ages of 34 weeks or more and PROM diagnosis. We extracted patient data from clinical records, including demographics, maternal history, medical profiles, and neonatal outcomes. Neonates were categorized based on symptoms, PROM duration, neonatal intensive care unit (NICU) stay, and respiratory support. Data underwent thematic analysis. Results: Of 275 neonates, the average PROM duration was 7.9 ± 8.1 hours, with 247 cases (89.8%) showing symptoms. Among them, 34 (12.4%) had PROM lasting over 18 hours, 48 (17.5%) were born prematurely, and 79 (28.7%) required intensive care. Symptomatic neonates had significantly higher rates of needing intensive care, respiratory support, prolonged antibiotics, and extended hospitalization (p < 0.05). NICU stays (≥3 days) were significantly associated with prematurity (odds ratio [OR] = 5.49; 95% CI, 2.39-12.60) and an initial pH level <7.25 (OR = 3.35; 95% CI, 1.46-7.68). Extended respiratory support (≥3 days) was significantly correlated with tocolysis ≥7 days (OR = 13.20; 95% CI, 3.94-44.20), Apgar score <7 at 1 minute after birth (OR = 4.28; 95% CI, 1.67-10.97), and inadequate intrapartum antibiotic prophylaxis (IAP) (OR = 2.34; 95% CI, 1.04-5.23). Conclusion: Neonates born at or after 34 weeks of gestation with PROM should undergo vigilant monitoring if early symptoms (<24 hours) manifest. Risk factors for requiring NICU care or extended respiratory support (≥3 days) include prematurity, low initial pH (<7.25), prolonged tocolysis requirement (≥7 days), an Apgar score below 7 at 1 minute, and inadequate IAP.

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“…It is a major concern in Obstetrics, given that it is associated with high risk of preterm deliveries when it occurs before term [5,6]. Other complications of PROM include cord prolapse, cesarean section risk, neonatal infections and perinatal death [7,8].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Premature Rupture of Membranes After Twenty-Eight Complete Weeks of Gestation

NKWABONG,

FOKO DJUIDJIE,

NGUEFACK

et al. 2023

Recent Trends Gynecol Obstet

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Purpose: To identify the risk factors for premature rupture of membranes (PROM). Materiel and Methods: This case-control study was carried out between 1st February and 31st July 2021. Files of women who delivered after having PROM or not were examined. The main variables recorded included maternal age and parity, familial, medical and obstetrical histories, the presence or not of nuchal cord at delivery, gestational age at delivery, birth weight and sex of newborn. Fisher exact test, t-test and logistic regression were used for comparison. P<0.05 was considered statistically significant. Results: Our frequency of PROM was 6.2% (94/1524 births). PROM occurred mostly at or after 37 weeks gestation (77.6%). Significant risk factors for PROM were 1st degree family history of PROM (aOR 31.36, 95%CI 2.57-382.11), fetal weight ≥4000g (aOR 14.78, 95%CI 2.72-80.20), cord round neck (aOR 6.36, 95%CI 1.17-34.66), past history of preterm delivery (aOR 3.42, 95%CI 1.02-11.52) and parity 4 or 5 (aOR 3.27, 95%CI 1.25-8.56). Conclusion: Women with these risk factors should be well followed up during pregnancy, especially during the third trimester, to allow prevention, if not, early diagnosis of PROM.

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Neonatal outcomes and risk of neonatal sepsis in an expectantly managed cohort of late preterm prelabor rupture of membranes

Cited by 5 publications

References 22 publications

Perinatal Outcomes of Late Preterm Rupture of Membranes with or without Latency Antibiotics

Perinatal Outcomes of Late Preterm Rupture of Membranes with or without Latency Antibiotics

The impact of premature rupture of membrane on neonatal outcomes in infants born at 34 weeks gestation or later

Risk Factors for Premature Rupture of Membranes After Twenty-Eight Complete Weeks of Gestation

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