Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Department of Pediatrics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2024 Jul 1;87(7):699-705. doi: 10.1097/JCMA.0000000000001108. Epub 2024 Jun 13.
Premature rupture of membranes (PROMs) is a known risk for adverse neonatal outcomes, often leading to neonatal hospitalization due to suspected perinatal infection or other issues. This study assesses PROM's clinical impact on neonatal outcomes in infants born at 34 weeks of gestation or later.
We studied hospitalized neonates born between December 2018 and November 2019, with gestational ages of 34 weeks or more and PROM diagnosis. We extracted patient data from clinical records, including demographics, maternal history, medical profiles, and neonatal outcomes. Neonates were categorized based on symptoms, PROM duration, neonatal intensive care unit (NICU) stay, and respiratory support. Data underwent thematic analysis.
Of 275 neonates, the average PROM duration was 7.9 ± 8.1 hours, with 247 cases (89.8%) showing symptoms. Among them, 34 (12.4%) had PROM lasting over 18 hours, 48 (17.5%) were born prematurely, and 79 (28.7%) required intensive care. Symptomatic neonates had significantly higher rates of needing intensive care, respiratory support, prolonged antibiotics, and extended hospitalization ( p < 0.05). NICU stays (≥3 days) were significantly associated with prematurity (odds ratio [OR] = 5.49; 95% CI, 2.39-12.60) and an initial pH level <7.25 (OR = 3.35; 95% CI, 1.46-7.68). Extended respiratory support (≥3 days) was significantly correlated with tocolysis ≥7 days (OR = 13.20; 95% CI, 3.94-44.20), Apgar score <7 at 1 minute after birth (OR = 4.28; 95% CI, 1.67-10.97), and inadequate intrapartum antibiotic prophylaxis (IAP) (OR = 2.34; 95% CI, 1.04-5.23).
Neonates born at or after 34 weeks of gestation with PROM should undergo vigilant monitoring if early symptoms (<24 hours) manifest. Risk factors for requiring NICU care or extended respiratory support (≥3 days) include prematurity, low initial pH (<7.25), prolonged tocolysis requirement (≥7 days), an Apgar score below 7 at 1 minute, and inadequate IAP.
胎膜早破（PROM）是新生儿不良结局的已知风险因素，常因疑似围产期感染或其他问题导致新生儿住院。本研究评估了 34 周或以上胎龄出生的婴儿中 PROM 对新生儿结局的临床影响。
我们研究了 2018 年 12 月至 2019 年 11 月期间住院的新生儿，胎龄为 34 周或以上，且有 PROM 诊断。我们从临床记录中提取了患者数据，包括人口统计学、母体病史、医疗概况和新生儿结局。根据症状、PROM 持续时间、新生儿重症监护病房（NICU）入住时间和呼吸支持情况对新生儿进行分类。数据进行了主题分析。
在 275 名新生儿中，PROM 持续时间平均为 7.9±8.1 小时，247 例（89.8%）出现症状。其中，34 例（12.4%）PROM 持续时间超过 18 小时，48 例（17.5%）早产，79 例（28.7%）需要重症监护。有症状的新生儿需要重症监护、呼吸支持、延长抗生素使用时间和延长住院时间的比例显著更高（p<0.05）。NICU 入住时间（≥3 天）与早产（比值比[OR] = 5.49；95%CI，2.39-12.60）和初始 pH 值<7.25（OR = 3.35；95%CI，1.46-7.68）显著相关。延长呼吸支持（≥3 天）与≥7 天的保胎治疗（OR = 13.20；95%CI，3.94-44.20）、出生后 1 分钟 Apgar 评分<7（OR = 4.28；95%CI，1.67-10.97）和宫内抗生素预防不足（IAP；OR = 2.34；95%CI，1.04-5.23）显著相关。
胎龄为 34 周或以上的新生儿如果出现早期症状（<24 小时），应进行密切监测。需要 NICU 护理或延长呼吸支持（≥3 天）的风险因素包括早产、初始 pH 值较低（<7.25）、保胎治疗时间延长（≥7 天）、1 分钟 Apgar 评分<7 和 IAP 不足。
