Risk of Early-Onset Sepsis following Preterm, Prolonged Rupture of Membranes with or without Chorioamnionitis.

ABSTRACT

OBJECTIVE: This study aims to determine whether preterm prolonged rupture of membranes (PPROM) increases the risk for early-onset sepsis (EOS) in preterm infants. STUDY DESIGN: Retrospective cohort study of infants 30 to 34 weeks' gestation from 2005 to 2014. Exposure to PPROM (rupture of membranes ≥ 18 hours) or chorioamnionitis (maternal temperature ≥ 38°C during delivery plus notation of chorioamnionitis in the medical record) was collected. The primary outcome was proven or suspected EOS. RESULTS: A total of 2,192 infants were included. Overall, 1,750 (80%) were not exposed to PPROM or chorioamnionitis (group 1), 381 (17%) were exposed to PPROM without chorioamnionitis (group 2), and 61 (3%) were exposed to chorioamnionitis ± PPROM (group 3). There was no difference in the incidence of proven or suspected EOS between groups 1 and 2 (5.4 vs. 5.5%, p = 0.86). Group 3 had a higher rate of EOS (24.6%) relative to groups 1 and 2 (p < 0.001). In multivariate analysis, risk of EOS was 4.1 times higher in infants exposed to chorioamnionitis. PPROM did not increase the risk of EOS in bivariate or multivariate analysis. CONCLUSION: In the absence of chorioamnionitis, PPROM does not increase the risk of proven or clinically suspected EOS in 30 to 34 weeks' gestation infants.