Izvorni znanstveni članak
https://doi.org/10.22514/SV132.112017.9
Impact of gestational age at PPROM on the shortterm outcome of children born after extreme and prolonged preterm prelabor rupture of membranes in an experienced care center
C. HOCQ
orcid.org/0000-0002-7255-6353
; Department of Neonatology, Cliniques Universitaires Saint Luc, Brussels, Belgium
B. VAN GRAMBEZEN
P. BERNARD
C. DEBAUCHE
Sažetak
Introduction. Survival of infants born after
extreme PPROM (preterm prelabor
rupture of membranes) has increased dramatically
in the past 20 years, up to 90%
in some tertiary neonatal centres, due to
the progress in neonatal cardiorespiratory
management.
Known risk factors of poor outcomes are
lower gestational age at PPROM and prolonged
and severe oligohydramnios.
Methods. We performed a retrospective
study over a 6-year-period (2009-2015),
including 14 pregnant women who experienced
PPROM, before 25 weeks of gestation,
with prolonged (>14 days) and severe
oligohydramnios (amniotic fluid index<5).
Each live neonate was matched with a control
patient who was born the same year,
of the same gender, with the same gestational
age (+/- 6 days) and who received
treatment to induce fetal lung maturation
at least 48 hours before birth.
Results. Live birth rate was 14/20 (70%)
and neonatal survival was 13/14 (93%).
Apgar scores at 5 and 10 minutes were
lower in the PPROM group (p<0.01). Intubation
was necessary for all babies with
PPROM and for 5/13 (38%) of the controls
(p < 0.01). In a subgroup analysis of
the PPROM group, we found that all babies
with PPROM < 20 weeks presented
refractory hypoxemia and required iNO
(inhaled nitric oxide) administration compared
to one in the PPROM group > 20
weeks (p < 0.01).
In all infants requiring iNO, the oxygenation
index improved dramatically and rapidly
with treatment.
We found no difference in the rate of bronchopulmonary
dysplasia, necrotizing enterocolitis,
retinopathy of prematurity or
intraventricular hemorrhage.
Conclusion. PPROM before 20 weeks of
gestation exposes the neonate to a high
risk of refractory hypoxemia compared
to PPROM after 20 weeks. The initial care
management requires more aggressive
treatment with administration of iNO in
all of them.
After the initial period, the evolution of all
babies born after PPROM is comparable to
that of their controls.
Ključne riječi
preterm prelabor rupture of membranes; oligohydramnios; pulmonary hypertension; pulmonary hypoplasia
Hrčak ID:
190599
URI
Datum izdavanja:
12.12.2017.
Posjeta: 1.606 *