Hanke Kathrin, Hartz Annika, Manz Maike, Bendiks Meike, Heitmann Friedhelm, Orlikowsky Thorsten, Müller Andreas, Olbertz Dirk, Kühn Thomas, Siegel Jens, von der Wense Axel, Wieg Christian, Kribs Angela, Stein Anja, Pagel Julia, Herting Egbert, Göpel Wolfgang, Härtel Christoph
Department of Pediatrics, University of Lübeck, Lübeck, Germany.
Department of Women's Health and Obstetrics University of Lübeck, Lübeck, Germany.
PLoS One. 2015 Apr 9;10(4):e0122564. doi: 10.1371/journal.pone.0122564. eCollection 2015.
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.
Observational, epidemiological study design.
Population-based cohort, German Neonatal Network (GNN).
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).
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.
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.
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.
本研究旨在评估胎膜早破（PPROM）作为早产原因对孕周小于32周的极低出生体重（VLBW）婴儿在初次住院期间死亡率及严重发病率的独立影响。
观察性流行病学研究设计。
基于人群的队列研究，德国新生儿网络（GNN）。
2009年至2012年，6102例VLBW婴儿纳入GNN，其中n = 4120例符合初步分析标准（孕周<32周，无先兆子痫、HELLP综合征（肝酶高度升高和血小板减少综合征）或胎盘早剥作为早产原因）。
多变量逻辑回归分析将PPROM作为不良结局的潜在危险因素，以及已确定的因素，如孕周、出生体重、产前使用类固醇、中心、顺产、多胎、性别和小于胎龄儿。
PPROM作为早产原因对早发型败血症、临床败血症和血培养证实败血症的风险无独立影响，而孕周是败血症风险的最重要因素。PPROM的诊断与支气管肺发育不良（BPD）风险增加相关（OR：1.25，95%CI：1.02 - 1.55，p = 0.03），但与其他主要结局无关。
除了BPD风险适度增加外，PPROM本身的诊断与孕周小于32周的VLBW婴儿的不良结局无关。需要进行以新生儿主要结局为指标的随机对照试验，以确定哪些VLBW婴儿亚组能从PPROM的期待治疗或计划性处理中获益。
