title: Neonatal survival after prolonged preterm premature rupture of membranes before 24 weeks of gestation.
abstract: OBJECTIVE
  To evaluate neonatal survival after prolonged preterm premature rupture of membranes (PROM) in the era of antenatal corticosteroids, surfactant, and inhaled nitric oxide.
  
  
  METHODS
  A single-center retrospective cohort study of neonates born from 2002-2011 after prolonged (1 week or more) preterm (less than 24 weeks of gestation) rupture of membranes was performed. The primary outcome was survival to discharge. Neonates whose membranes ruptured less than 24 hours before delivery (n=116) were matched (2:1) on gestational age at birth, sex, and antenatal corticosteroid exposure with neonates whose membranes ruptured 1 week or more before delivery (n=58). Analysis used conditional logistic regression for categorical data and Wilcoxon signed rank test for continuous data.
  
  
  RESULTS
  The prolonged preterm PROM exposed and unexposed cohorts had survival rates of 90% and 95%, respectively, although underpowered to assess the statistical significance (P=.313). Exposed neonates were more likely have pulmonary hypoplasia (26/58 exposed, 1/114 unexposed, P<.001), pulmonary hypertension (21/56 exposed, 10/112 unexposed, P<.001), and pulmonary air leak (21/58 exposed, 14/114 unexposed, P<.001). Gestational age at rupture (20.4 weeks exposed, 22.3 weeks unexposed, P=.189), length of rupture (3.7 weeks exposed, 6.4 weeks unexposed, P=.717), and lowest maximal vertical pocket before 24 weeks of gestation (0 cm exposed, 1.4 cm unexposed, P=.114) did not discriminate between survivors and nonsurvivors after exposure to prolonged preterm PROM.
  
  
  CONCLUSIONS
  With antenatal steroid exposure and aggressive pulmonary management, survival to discharge after prolonged preterm PROM was 90%. Pulmonary morbidities were common. Of note, the data were limited to women who remained pregnant 1 week or longer after rupture of membranes.
authors.affiliation: Stead Family Department of Pediatrics, the Department of Obstetrics and Gynecology, and the College of Liberal Arts and Sciences, University of Iowa, Iowa City, Iowa.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Brumbaugh
authors.forename: Tarah T
authors.initials: TT
authors.lastname: Colaizy
authors.forename: Nina
authors.initials: N
authors.lastname: Nuangchamnong
authors.forename: Emily A
authors.initials: EA
authors.lastname: O'Brien
authors.forename: Diedre K
authors.initials: DK
authors.lastname: Fleener
authors.forename: Asha
authors.initials: A
authors.lastname: Rijhsinghani
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Klein
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000401:mortality*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality / Q000517:prevention & control; D007484:Iowa / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis