The neonatal significance of selected perinatal events among infants of low birth weight. II. The influence of ruptured membranes.

A retrospective study was made of 356 infants who weighed less than 2,001 grams. One hundred thirty-three babies were delivered after premature rupture of the membranes. Nonaggressive management was utilized in uncomplicated situations. Vaginal examination was prohibited. Delivery was accomplished only for infection, abnormal presentation, bleeding, labor, or maternal complications. Corticosteroids were not used. There was significantly better survival of babies who weighed 500 to 1,200 grams than of the control infants. Babies who weighed 1,201 to 2,000 grams showed no significant difference. The advantages with ruptured membranes was also noticed among babies less than 30 weeks' gestation by mothers' date and newborn assessment. The advantages were noticed primarily among infants with membranes ruptured more than 48 hours. Appropriate for gestational age (AGA) babies survived more often than small for gestational age (SGA) babies. The incidence of respiratory complications was not altered. The incidence of maternal fever was significantly higher among patients referred for care than among our own. Mortality among referred febrile patients was higher than among our own; no deaths occurred among the latter. Few cases of sepsis occurred, and there were no deaths caused purely by sepsis. The suggestion is that prolonged ruptured membranes in infants of very low birth weight confers some advantage. This advantage may be abolished if fever is prolonged, and infection may be promoted by vaginal examination.