Preterm Prelabor Rupture of Membranes and Outcome of Very-Low-Birth-Weight Infants in the German Neonatal Network

Abstract

ObjectiveIt was the aim of our study to evaluate the independent effect of preterm prelabor rupture of membranes (PPROM) as a cause of preterm delivery on mortality during primary hospital stay and significant morbidities in very-low-birth-weight (VLBW) infants < 32 weeks of gestation.DesignObservational, epidemiological study design.SettingPopulation-based cohort, German Neonatal Network (GNN).Population6102 VLBW infants were enrolled in GNN from 2009-2012, n=4120 fulfilled criteria for primary analysis (< 32 gestational weeks, no pre-eclampsia, HELLP (highly elevated liver enzymes and low platelets syndrome) or placental abruption as cause of preterm birth).MethodsMultivariable logistic regression analyses included PPROM as potential risk factors for adverse outcomes and well established items such as gestational age in weeks, birth weight, antenatal steroids, center, inborn delivery, multiple birth, gender and being small-for-gestational-age.ResultsPPROM as cause of preterm delivery had no independent effect on the risk of early-onset sepsis, clinical sepsis and blood-culture proven sepsis, while gestational age proved to be the most important contributor to sepsis risk. The diagnosis of PPROM was associated with an increased risk for bronchopulmonary dysplasia (BPD; OR: 1.25, 95% CI: 1.02-1.55, p=0.03) but not with other major outcomes.ConclusionsThe diagnosis of PPROM per se is not associated with adverse outcome in VLBW infants < 32 weeks apart from a moderately increased risk for BPD. Randomized controlled trials with primary neonatal outcomes are needed to determine which subgroup of VLBW infants benefit from expectant or intentional management of PPROM.

An Echocardiographic Screening Program Helps to Identify Pulmonary Hypertension in Extremely Low Birthweight Infants with and without Bronchopulmonary Dysplasia: A Single-Center Experience

“…Additionally, we found PROM >7 days as another clinical risk factor of PH. This finding is also supported by data from other groups [19,20]. …”

Bronchopulmonary Dysplasia Frequency and Risk Factors in Very Low Birth Weight İnfants: a 3-Year Retrospective Study

“…The possible fetal effects of EMR are not clearly understood because mild perinatal inflammation is reported to have possible positive effects on fetal immune system maturation [27]. Comprehensive research published by the German Neonatal Group in 2015 revealed that EMR was only a risk factor for BPD in the chronic period (OR 1.25, 95% CI 1.02-1.55, p=0.03) [28]. In our study, this risk level was found to be higher (OR 2.6, 95% CI 1.2-5.5, p=0.01, Table 2).…”

Sinnvolle Steroidprophylaxe bei drohender Frühgeburt – State of the art

“…Eine Vielzahl an Studien, die über die Jahre erschienen, insbesondere die Cochrane-Analyse von 2006 und die Daten aus dem GNN-Register für die Jahre 2009-2012, beweisen die eindeutigen Vorteile der Prophylaxe mit antenatalen Steroiden, die sich nicht nur auf das respiratorische System beschränken [4,22]. Zur Förderung der Akzeptanz dieser Maßnahme bei Ärzten, Hebammen und Eltern ist es deshalb sinnvoll, den Begriff "Lungenreifung" nicht mehr zu verwenden, sondern bspw.…”

“…Unter deren Anwendung kommt es zu einer deutlichen Reduktion der allgemeinen Mortalität und Morbidität. Die Rate an neonatalen Infektionen nimmt ebenso ab, wie die Rate an NEC, IVH/ PVL und ROP [4,[22][23][24][25][26]. Zusätzlich wird, analog zur ursprünglichen Beobachtung von Liggins, die Beatmungsnotwendigkeit gesenkt, da das RDS seltener auftritt.…”