title: Preterm prelabor rupture of membranes and outcome of very-low-birth-weight infants in the German Neonatal Network.
abstract: OBJECTIVE
  It 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.
  
  
  METHODS
  Observational, epidemiological study design.
  
  
  METHODS
  Population-based cohort, German Neonatal Network (GNN).
  
  
  METHODS
  6102 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).
  
  
  METHODS
  Multivariable 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.
  
  
  RESULTS
  PPROM 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.
  
  
  CONCLUSIONS
  The 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.
authors: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors: Kathrin
authors: K
authors: Hanke
authors: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors: Annika
authors: A
authors: Hartz
authors: Department of Women's Health and Obstetrics University of Lübeck, Lübeck, Germany.
authors: Maike
authors: M
authors: Manz
authors: Department of Pediatrics at University of Kiel, Kiel, Germany.
authors: Meike
authors: M
authors: Bendiks
authors: Children's Hospital Dortmund, Dortmund, Germany.
authors: Friedhelm
authors: F
authors: Heitmann
authors: Department of Pediatrics, University of Aachen, Aachen, Germany.
authors: Thorsten
authors: T
authors: Orlikowsky
authors: Department of Pediatrics, University of Bonn, Bonn, Germany.
authors: Andreas
authors: A
authors: Müller
authors: Children's Hospital Rostock, Rostock, Germany.
authors: Dirk
authors: D
authors: Olbertz
authors: Vivantes Children's Hospital Berlin-Neukölln, Berlin, Germany.
authors: Thomas
authors: T
authors: Kühn
authors: Children's Hospital Auf der Bult Hanover, Hanover, Germany.
authors: Jens
authors: J
authors: Siegel
authors: Children's Hospital Hamburg-Altona, Hamburg, Germany.
authors: Axel
authors: A
authors: von der Wense
authors: Children's Hospital Aschaffenburg, Aschaffenburg, Germany.
authors: Christian
authors: C
authors: Wieg
authors: Department of Pediatrics, University of Cologne, Cologne, Germany.
authors: Angela
authors: A
authors: Kribs
authors: Department of Pediatrics, University of Essen, Essen, Germany.
authors: Anja
authors: A
authors: Stein
authors: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors: Julia
authors: J
authors: Pagel
authors: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors: Egbert
authors: E
authors: Herting
authors: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors: Wolfgang
authors: W
authors: Göpel
authors: Department of Pediatrics, University of Lübeck, Lübeck, Germany.
authors: Christoph
authors: C
authors: Härtel
mesh_terms: D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology* / Q000503:physiopathology*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D016015:Logistic Models; D009026:Mortality; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology* / Q000209:etiology*