Pharande Pramod, Mohamed Abdel-Latif, Bajuk Barbara, Lui Kei, Bolisetty Srinivas
Division of Newborn Services, Royal Hospital for Women, Sydney, New South Wales, Australia.
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
BMJ Paediatr Open. 2017 Dec 29;1(1):e000216. doi: 10.1136/bmjpo-2017-000216. eCollection 2017.
To determine the hospital outcomes of liveborn infants at 23-31 weeks following prelabour preterm rupture of membranes (PPROM).
A regional retrospective cohort study of 4454 infants of 23-31 weeks' gestation admitted to a tertiary neonatal network between 2007 and 2011. Primary outcome was the composite chronic lung disease (CLD) or mortality at discharge.
225 (5%) neonates had a history of PPROM occurring prior to 24 weeks (Early-PPROM), 829 (19%) had a history of PPROM at or after 24 weeks' gestation (Late-PPROM) and 3400 (76%) had no history of PPROM (No-PPROM). In comparison to No-PPROM, Early-PPROM group had higher CLD/mortality in infants born at 23-27 weeks (OR 1.95; 95% CI 1.34 to 2.85) and 28-31 weeks (OR 4.98; 95% CI 2.99 to 8.28). Within Early-PPROM group, the latency of PPROM >14 days had lower CLD/mortality in comparison to latency ≤14 days (57.6% vs 77%, OR 0.40; 95% CI 0.21 to 0.76). Late-PPROM group had significantly lower CLD/mortality in comparison to No-PPROM group at 23-27 weeks (OR 0.50; 95% CI 0.37 to 0.69) and 28-31 weeks (OR 0.50; 95% CI 0.36 to 0.71). Within Late-PPROM group, latency >14 days was associated with an increased CLD/mortality in 28-31 weeks (14.1% vs 5.4%, OR 2.88; 95% CI 1.31 to 6.38).
Early-PPROM prior to 24 weeks' gestation had high incidence of CLD/mortality even after correcting for gestational age. Late-PPROM at or after 24 weeks had lower CLD/mortality compared with No-PPROM. Latency >14 days in Late-PPROM group at 28-31 week group increased the odds of CLD/mortality.
确定妊娠23 - 31周的活产婴儿在临产前胎膜早破（PPROM）后的医院结局。
一项对2007年至2011年间入住三级新生儿网络的4454例妊娠23 - 31周婴儿的区域性回顾性队列研究。主要结局是出院时的复合慢性肺病（CLD）或死亡率。
225例（5%）新生儿有妊娠24周前发生PPROM的病史（早期PPROM），829例（19%）有妊娠24周及以后发生PPROM的病史（晚期PPROM），3400例（76%）无PPROM病史（无PPROM）。与无PPROM相比，早期PPROM组在妊娠23 - 27周出生的婴儿中CLD/死亡率更高（比值比1.95；95%置信区间1.34至2.85），在妊娠28 - 31周出生的婴儿中也是如此（比值比4.98；95%置信区间2.99至8.28）。在早期PPROM组中，PPROM潜伏期>14天的CLD/死亡率低于潜伏期≤14天的（57.6%对77%，比值比0.40；95%置信区间0.21至0.76）。晚期PPROM组在妊娠23 - 27周（比值比0.50；95%置信区间0.37至0.69）和妊娠28 - 31周（比值比0.50；95%置信区间0.36至0.71）时，与无PPROM组相比CLD/死亡率显著更低。在晚期PPROM组中，潜伏期>14天与妊娠28 - 31周时CLD/死亡率增加相关（14.1%对5.4%，比值比2.88；95%置信区间1.31至6.38）。
妊娠24周前的早期PPROM即使校正胎龄后CLD/死亡率发生率仍很高。妊娠24周及以后的晚期PPROM与无PPROM相比CLD/死亡率更低。晚期PPROM组在妊娠28 - 31周时潜伏期>14天增加了CLD/死亡率的几率。
