Neonatal Outcomes at 2 Years following Expectant Management of Previable Premature Prelabor Rupture of Membranes at a Single Center.

ABSTRACT

Previable premature prelabor rupture of membranes (pPPROM) can lead to significant maternal and neonatal morbidity and mortality. Limited literature exists describing long-term outcomes in neonates surviving pPPROM. Our study describes 2-year survival and outcomes after expectantly managed pPPROM at a single, tertiary, academic center. This is a retrospective review including individuals with pPPROM defined as membrane rupture before 240/7 weeks who were candidates and opted for expectant management at a single tertiary academic center between 2013 and 2022. Patients were included if they delivered after 22 weeks. Patients opting for termination, with contraindication to expectant management or who chose expectant management without planned neonatal resuscitation at birth were excluded. Electronic records of patients and associated neonates were reviewed for demographic information, PPROM management, and neonatal outcomes at 2 years including gastrointestinal, respiratory, cognitive, motor, and hearing or vision issues. Descriptive statistical analysis was performed. Of 111 pregnancies with pPPROM, 50(45%) pregnant individuals met inclusion criteria (46 singletons; 4 multiples [3 twins, 1 set of quads]). Of 46 singletons, 31 (67%) survived to 2 years with 1(3%) alive but less than 2 years. In 3/4 (75%) twin gestations, both twins survived to 2 years. A total of 3/4 (75%) quadruplets survived to 2 years. Most surviving infants (95.0%, n = 38) had at least one documented adverse outcome. A total of 55.0% (n = 22) of neonates had gross motor delay, and 77.5% (n = 31) had documented speech delay. Most had respiratory issues with reactive airway disease most common (22.5% n = 9). Gastrointestinal issues were common with gastrostomy tube in 32.5% (n = 13) and short gut syndrome in 15% (n = 6). Over half of neonates with expectantly managed pPPROM survived with high rates of adverse outcomes with over half with documented gross motor and speech delay present at 2 years. Respiratory and gastrointestinal issues were also common. These data provide information for important patient counseling on long-term outcomes in expectantly managed pPPROM. KEY POINTS · Adverse outcomes at 2 years after pPPROM were prevalent.. · Speech delay at 2 years was the most common outcome.. · Motor delay occurred in 55% of neonates at 2 years.. · Long-term pPPROM data can guide counseling..