Lorthe Elsa, Ancel Pierre-Yves, Torchin Héloïse, Kaminski Monique, Langer Bruno, Subtil Damien, Sentilhes Loïc, Arnaud Catherine, Carbonne Bruno, Debillon Thierry, Delorme Pierre, D'Ercole Claude, Dreyfus Michel, Lebeaux Cécile, Galimard Jacques-Emmanuel, Vayssiere Christophe, Winer Norbert, L'Helias Laurence Foix, Goffinet François, Kayem Gilles
Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Sorbonne Universités, University Pierre and Marie Curie, Paris 06, Institut de Formation Doctorale, Paris, France.
Inserm Unité Mixte de Recherche (UMR) 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, Département Hospitalo-Universitaire Risks in Pregnancy, Paris Descartes University, Paris, France; Unité de Recherche Clinique-Centre d'Investigations Cliniques P1419, Cochin Hotel-Dieu Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
J Pediatr. 2017 Mar;182:47-52.e2. doi: 10.1016/j.jpeds.2016.11.074. Epub 2017 Jan 9.
To assess the impact of latency duration on survival, survival without severe morbidity, and early-onset sepsis in infants born after preterm premature rupture of membranes (PPROM) at 24-32 weeks' gestation.
This study was based on the prospective national population-based Etude Épidémiologique sur les Petits Ȃges Gestationnels 2 cohort of preterm births and included 702 singletons delivered in France after PPROM at 24-32 weeks' gestation. Latency duration was defined as the time from spontaneous rupture of membranes to delivery, divided into 4 periods (12 hours to 2 days [reference], 3-7 days, 8-14 days, and >14 days). Multivariable logistic regression was used to assess the relationship between latency duration and survival, survival without severe morbidity at discharge, or early-onset sepsis.
Latency duration ranged from 12 hours to 2 days (18%), 3-7 days (38%), 8-14 days (24%), and >14 days (20%). Rates of survival, survival without severe morbidity, and early-onset sepsis were 93.5% (95% CI 91.8-94.8), 85.4% (82.4-87.9), and 3.4% (2.0-5.7), respectively. A crude association found between prolonged latency duration and improved survival disappeared on adjusting for gestational age at birth (aOR 1.0 [reference], 1.6 [95% CI 0.8-3.2], 1.2 [0.5-2.9], and 1.0 [0.3-3.2] for latency durations from 12 hours to 2 days, 3-7 days, 8-14 days, and >14 days, respectively). Prolonged latency duration was not associated with survival without severe morbidity or early-onset sepsis.
For a given gestational age at birth, prolonged latency duration after PPROM does not worsen neonatal prognosis.
评估孕24 - 32周胎膜早破（PPROM）后出生的婴儿潜伏期时长对其生存、无严重并发症生存以及早发性败血症的影响。
本研究基于法国全国前瞻性基于人群的小孕周队列研究2中的早产队列，纳入了702例孕24 - 32周PPROM后在法国分娩的单胎婴儿。潜伏期时长定义为从胎膜自然破裂到分娩的时间，分为4个时间段（12小时至2天[参照组]、3 - 7天、8 - 14天以及>14天）。采用多变量逻辑回归评估潜伏期时长与生存、出院时无严重并发症生存或早发性败血症之间的关系。
潜伏期时长范围为12小时至2天（18%）、3 - 7天（38%）、8 - 14天（24%）以及>14天（20%）。生存、无严重并发症生存以及早发性败血症的发生率分别为93.5%（95%可信区间91.8 - 94.8）、85.4%（82.4 - 87.9）以及3.4%（2.0 - 5.7）。在调整出生孕周后，最初发现的潜伏期延长与生存改善之间的粗略关联消失（对于潜伏期时长为12小时至2天、3 - 7天、8 - 14天以及>14天，调整后的比值比分别为1.0[参照组]、1.6[95%可信区间0.8 - 3.2]、1.2[0.5 - 2.9]以及1.0[0.3 - 3.2]）。潜伏期延长与无严重并发症生存或早发性败血症无关。
对于给定的出生孕周，PPROM后潜伏期延长不会使新生儿预后恶化。
