Prolonged premature rupture of membranes in the preterm infant: a 7 year study.
OBJECTIVE
To review the outcome of infants born following prolonged and preterm rupture of the membranes.


METHODS
retrospective and partially prospective observational study.


METHODS
babies born in and referred to a tertiary neonatal centre.


METHODS
117 preterm infants, median gestation (range) = 29.5 (25-36) weeks, seen over a 7 year period with membranes ruptured for more than 4 days; median (range) = 9 (4-119) days.


METHODS
survival and cause of death, compression deformities, pulmonary hypoplasia and infection.


RESULTS
23 infants died, 11 from pulmonary hypoplasia and 11 as a direct consequence of prematurity (3 from hyaline membrane disease, 7 from bronchopulmonary dysplasia and one from necrotising enterocolitis developed on day 17). One infant had a lethal congenital abnormality and died untreated of overwhelming infection. No other infants died of infection. 94% of infants were treated with broad-spectrum antibiotics after birth. Compression deformities were seen in 25 infants: median duration of membrane rupture 28 days, range 4-119. In those without deformity, median duration was 7 days, range 4-105. Sixteen infants had pulmonary hypoplasia (median 31, range 14-119), 11 died (median 37, range 21-112) and five survived (median 23, range 14-119). Although the median duration of membrane rupture in infants dying of pulmonary hypoplasia was longer than in those who did not have hypoplasia (31 compared to 7 days), 13 of 27 (48%) of infants whose membranes were ruptured for 4 weeks and 4 of 7 (57%) whose membranes were ruptured more than 70 days survived.


CONCLUSIONS
death from pulmonary hypoplasia is a much more serious problem following preterm prolonged membrane rupture than is infection. Pulmonary hypoplasia is not inevitable even after prolonged periods of membrane rupture.
McIntosh
N
N
Department of Child Life and Health, University of Edinburgh, UK.
Harrison
A
A
D001424:Bacterial Infections / Q000209:etiology*; D001997:Bronchopulmonary Dysplasia / Q000209:etiology* / Q000401:mortality; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D006819:Hyaline Membrane Disease / Q000209:etiology / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008168:Lung / Q000002:abnormalities*; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate