Younge Noelle E, Saha Shampa, Brumbaugh Jane E, Klein Jonathan M, Bell Edward F, Colaizy Tarah T, Hughes Brenna L, Malcolm William F, Goldberg Ronald N, Wyckoff Myra H, Van Meurs Krisa P, Das Abhik, Cotten C Michael
Department of Pediatrics, Duke University School of Medicine, Durham, NC.
Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC.
Am J Obstet Gynecol. 2025 Jan 10. doi: 10.1016/j.ajog.2025.01.010.
Preterm prelabor rupture of membranes before or around the limit of fetal viability is associated with serious maternal and neonatal complications, including chorioamnionitis, extremely preterm birth, and pulmonary hypoplasia.
This study aimed to describe the contemporary outcomes of extremely preterm infants born after prolonged periviable preterm prelabor rupture of membranes and to identify perinatal factors associated with survival and survival without severe neurodevelopmental impairment.
Among actively treated infants born alive at <27 weeks' gestational age in centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 2012 to 2018, the outcomes of survival and survival without severe neurodevelopmental impairment at 22 to 26 months' corrected age were compared between infants exposed to prolonged (≥120 hours) periviable (<24 weeks' gestational age) preterm prelabor rupture of membranes and unexposed infants born after rupture of membranes ≤18 hours before delivery or at delivery with adjustment for birth gestational age, sex, multiple gestation, antenatal steroids, small for gestational age, insurance, and center. Regression models were used to identify perinatal factors associated with survival and survival without severe neurodevelopmental impairment among the infants exposed to prolonged periviable preterm prelabor rupture of membranes.
The analysis included 609 infants exposed to prolonged periviable preterm prelabor rupture of membranes and 4489 unexposed infants. In the prolonged periviable preterm prelabor rupture of membranes group, 444 of 608 (73%) infants survived and 298 of 533 (56%) infants survived without severe neurodevelopmental impairment. The odds of survival (odds ratio, 0.84; 95% confidence interval, 0.68-1.05) and survival without severe neurodevelopmental impairment (odds ratio, 0.91; 95% confidence interval, 0.75-1.12) were not significantly different between prolonged periviable preterm prelabor rupture of membranes and unexposed groups. The variables associated with higher odds of survival without severe neurodevelopmental impairment were later gestational age at birth (odds ratio, 1.37; 95% confidence interval, 1.13-1.67), later gestational age at preterm prelabor rupture of membranes (odds ratio, 1.44; 95% confidence interval, 1.26-1.63), and female sex (odds ratio, 1.57; 95% confidence interval, 1.06-2.34), whereas small-for-gestational-age infants had lower odds of survival without severe neurodevelopmental impairment (odds ratio, 0.14; 95% confidence interval, 0.04-0.51).
The odds of survival and survival without severe neurodevelopmental impairment among infants exposed to prolonged periviable preterm prelabor rupture of membranes were not significantly different from those of unexposed infants but decreased with earlier gestational age at birth and rupture of membranes.
在胎儿可存活极限之前或左右发生的早产前胎膜早破与严重的母婴并发症相关，包括绒毛膜羊膜炎、极早早产和肺发育不全。
本研究旨在描述在可存活早产前胎膜早破延长后出生的极早早产儿的当代结局，并确定与存活及无严重神经发育障碍存活相关的围产期因素。
在2012年至2018年期间，于尤妮斯·肯尼迪·施赖弗国家儿童健康与人类发展研究所新生儿研究网络各中心出生且孕周<27周并接受积极治疗的存活婴儿中，比较暴露于延长（≥120小时）可存活（<24周孕周）早产前胎膜早破的婴儿与胎膜破裂发生在分娩前≤18小时或分娩时的未暴露婴儿在22至26个月校正年龄时的存活及无严重神经发育障碍存活结局，并对出生孕周、性别、多胎妊娠、产前使用类固醇、小于胎龄、保险情况和中心进行校正。采用回归模型确定暴露于延长可存活早产前胎膜早破的婴儿中与存活及无严重神经发育障碍存活相关的围产期因素。
分析纳入609例暴露于延长可存活早产前胎膜早破的婴儿和4489例未暴露婴儿。在延长可存活早产前胎膜早破组中，608例婴儿中有444例（73%）存活，533例婴儿中有298例（56%）存活且无严重神经发育障碍。延长可存活早产前胎膜早破组与未暴露组在存活几率（比值比，0.84；95%置信区间，0.68 - 1.05）和无严重神经发育障碍存活几率（比值比，0.91；95%置信区间，0.75 - 1.12）方面无显著差异。与无严重神经发育障碍存活几率较高相关的变量包括出生时孕周较大（比值比，1.37；95%置信区间，1.13 - 1.67）、早产前胎膜早破时孕周较大（比值比，1.44；95%置信区间，1.26 - 1.63）以及女性性别（比值比，1.57；95%置信区间，1.06 - 2.34），而小于胎龄儿无严重神经发育障碍存活几率较低（比值比，0.14；95%置信区间，0.04 - 0.51）。
暴露于延长可存活早产前胎膜早破的婴儿的存活及无严重神经发育障碍存活几率与未暴露婴儿无显著差异，但随出生及胎膜早破时孕周提前而降低。
