Outcome at Two Years of Very Preterm Infants Born after Rupture of Membranes before Viability.
OBJECTIVE
To compare the respiratory and neurological outcomes at two years of age of preterm children born before 33 weeks of gestation (WG) after early preterm premature rupture of membranes (EPPROM) between 14 and 24 WG with preterm children without EPPROM.


METHODS
This single-center case-control retrospective study was conducted at Rouen University Hospital between 1st January 2000 and 31st December 2010. All the cases with EPPROM born from 26WG to 32WG were included. Each newborn was matched by sex, gestational age (GA) and year of birth to two very preterm children, born without EPPROM. At two years of corrected age, motor and cognitive abilities were assessed by routine score based on the Amiel-Tison and Denver developmental scales.


RESULTS
Ninety-four cases with EPPROM before 24WG have been included. The 31 children born from 26WG to 32WG were matched with 62 controls. The EPPROM group had poorer clinical evaluation at one year for motor (p = 0.003) and cognitive developmental scores (p = 0.016). Neuromotor rehabilitation was performed more often (p = 0.013). However, there was no difference at 2 years of age. Children born after EPPROM were hospitalized more often for bronchiolitis (p<0.001) during their first 2 years, which correlates with increased incidence of pneumothorax (p = 0.017), pulmonary hypoplasia (p = 0.004) and bronchopulmonary dysplasia (p = 0.005) during neonatal period.


CONCLUSIONS
At two years, despite an increase in severe bronchiolitis and the need for more neuromotor rehabilitation during the first month of the life after discharge, there was no difference in neurological outcomes in the very preterm children of the EPPROM group compared to those born at a similar GA without EPPROM.
Department of Neonatal Medicine, Functional Education Centre for the Child and Reference Centre for learning disabilities, Rouen University Hospital, Rouen, France.|Region-Inserm team (ERI 28) "Neovasc", Microvascular endothelium and perinatal cerebral lesions, Institute for Biomedical Research and Innovation, School of Medicine, Rouen University, Rouen, France.
Amelie
A
Kieffer
Department of Neonatal Medicine, Functional Education Centre for the Child and Reference Centre for learning disabilities, Rouen University Hospital, Rouen, France.|Region-Inserm team (ERI 28) "Neovasc", Microvascular endothelium and perinatal cerebral lesions, Institute for Biomedical Research and Innovation, School of Medicine, Rouen University, Rouen, France.
Gaelle
G
Pinto Cardoso
Department of Biostatistics, Rouen University Hospital, Rouen, France.
Caroline
C
Thill
Region-Inserm team (ERI 28) "Neovasc", Microvascular endothelium and perinatal cerebral lesions, Institute for Biomedical Research and Innovation, School of Medicine, Rouen University, Rouen, France.|Department of Obstetrics, Rouen University Hospital, Rouen, France.
Eric
E
Verspyck
Department of Neonatal Medicine, Functional Education Centre for the Child and Reference Centre for learning disabilities, Rouen University Hospital, Rouen, France.|Region-Inserm team (ERI 28) "Neovasc", Microvascular endothelium and perinatal cerebral lesions, Institute for Biomedical Research and Innovation, School of Medicine, Rouen University, Rouen, France.
Stéphane
S
Marret
D000328:Adult; D016022:Case-Control Studies; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D003071:Cognition; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature / Q000254:growth & development / Q000502:physiology*; D008297:Male; D009048:Motor Skills / Q000502:physiology; D011247:Pregnancy; D012189:Retrospective Studies