title: Gestational age is more important for short-term neonatal outcome than microbial invasion of the amniotic cavity or intra-amniotic inflammation in preterm prelabor rupture of membranes.
abstract: BACKGROUND
  The aim of this study was to evaluate, in women with preterm prelabor rupture of membranes (PPROM), the impact on short-term neonatal outcome of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation (IAI), and the microorganisms isolated in women with MIAC, when gestational age is taken into account.
  
  
  METHODS
  Prospective cohort study. We included women with PPROM (22.0-34.0 weeks of gestation) with available information about MIAC, IAI and short-term neonatal outcome. MIAC was defined as positive aerobic/anaerobic/genital Mycoplasma culture in amniotic fluid. Definition of IAI was based on interleukin-6 levels in amniotic fluid. Main outcome measures were Apgar score <7 at 5 min, umbilical artery pH ≤7.0, days in the neonatal intensive care unit, and composite neonatal morbidity, including any of the following: intraventricular hemorrhage grade III-IV, respiratory distress syndrome, early-onset neonatal sepsis, periventricular leukomalacia, necrotizing enterocolitis, and fetal or neonatal death. Labor was induced after 32.0 weeks if lung maturity was confirmed; and otherwise after 34.0 weeks.
  
  
  RESULTS
  MIAC and IAI were found in 38% (72/190) and 67% (111/165), respectively. After adjustment for gestational age at delivery, no differences in short-term neonatal outcome were found between women with either MIAC or IAI, compared with the non-infection/non-inflammation ("No-MIAC/No-IAI") group. Furthermore, short-term neonatal outcome did not differ between the MIAC caused by Ureaplasma spp. group, the MIAC caused by other microorganisms group and the "No-MIAC/No-IAI" group.
  
  
  CONCLUSIONS
  Gestational age at delivery seems to be more important for short-term neonatal outcome than MIAC or IAI in PPROM.
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Adriano
authors.initials: A
authors.lastname: Rodríguez-Trujillo
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cobo
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Vives
authors.affiliation: Microbiology, Biomedical Diagnostic Center, Hospital Clínic and ISGlobal Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: Marian
authors.initials: M
authors.lastname: Kacerovsky
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: David E
authors.initials: DE
authors.lastname: Posadas
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Martina A
authors.initials: MA
authors.lastname: Ángeles
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacós
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.|Department of Genetics and Bioinformatics, Area of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Bo
authors.initials: B
authors.lastname: Jacobsson
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.|Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Palacio
mesh_terms: D000653:Amniotic Fluid / Q000382:microbiology*; D001034:Apgar Score; D001420:Bacteria, Aerobic / Q000302:isolation & purification; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D002821:Chorioamnionitis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000382:microbiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000628:therapy; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D016015:Logistic Models; D009174:Mycoplasma / Q000302:isolation & purification; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D014509:Ureaplasma / Q000302:isolation & purification
keywords: Interleukin-6; intra-amniotic inflammation; microbial invasion of the amniotic cavity; preterm birth; preterm prelabor rupture of membranes; short-term neonatal outcome