Neonatal outcomes and risk of neonatal sepsis in an expectantly managed cohort of late preterm prelabor rupture of membranes
| Autor: | Sara Consonni, Noemi Strambi, Mariarosaria Di Tommaso, Chiara Comerio, Sofia Gambigliani Zoccoli, Marta Betti, Fabio Facchinetti, Anna Cappello, Giuseppe Chiossi, Patrizia Vergani, Viola Seravalli, Anna Locatelli, Francesca Monari |
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| Přispěvatelé: | Chiossi, G, Di Tommaso, M, Monari, F, Consonni, S, Strambi, N, Zoccoli, S, Seravalli, V, Comerio, C, Betti, M, Cappello, A, Vergani, P, Facchinetti, F, Locatelli, A |
| Rok vydání: | 2020 |
| Předmět: |
Antenatal corticosteroids
medicine.medical_specialty Fetal Membranes Premature Rupture medicine.medical_treatment Premature prelabor rupture of membrane Gestational Age Prom Hypoglycemia 03 medical and health sciences 0302 clinical medicine Pregnancy Late preterm Premature prelabor rupture of membranes Rupture of membranes Medicine Humans 030212 general & internal medicine Watchful Waiting Retrospective Studies Mechanical ventilation 030219 obstetrics & reproductive medicine Neonatal sepsis business.industry Obstetrics Infant Newborn Obstetrics and Gynecology Gestational age Infant Retrospective cohort study medicine.disease Antenatal corticosteroid Reproductive Medicine Cohort Premature Birth Female Neonatal sepsi Neonatal Sepsis business |
| Zdroj: | European journal of obstetrics, gynecology, and reproductive biology. 261 |
| ISSN: | 1872-7654 |
| Popis: | Objective: Expectant management in patients with prelabor preterm rupture of membranes between between 340/7 and 36 6/7 weeks (late preterm pPROM or LpPROM) has been shown to decrease the burden of prematurity, when compared to immediate delivery. As the severity of prematurity depends on gestational age (GA) at PROM, and PROM to delivery interval, we first investigated how such variables affect neonatal outcomes (NO). Second, we assessed the risk of neonatal sepsis. Study design: retrospective cohort study on neonatal morbidity among singleton infants born to expectantly managed mothers with LpPROM in five hospitals affiliated with three Italian academic institutions. The primary NO was a composite of neonatal death, non-invasive (cPAP) or invasive (mechanical ventilation) respiratory support, hypoglycemia (< 44 mg/dl needing therapy), newborn sepsis, confirmed seizures, stroke, intraventricular hemorrhage (IVH), basal nuclei anomalies, cardiopulmonary resuscitation, umbilical-cord-blood arterial pH < 7.0 or base excess < -12.5, and prolonged hospitalization (≥ 5 days). Univariate analysis described differences in the population according to GA at delivery. Multivariate logistic regression was then used to investigate the effects of GA at PROM, and PROM to delivery interval on the NO. Results: 258/606 (42.6 %) women with LpPROM were expectantly managed, as they did not deliver within the first 24 h. The median latency duration was 2 (95 %CI 1−3) days, having no effect on neonatal morbidity on multivariate analysis. Multivariate analysis also showed increased risks of adverse NO among PROM at 34 (OR 2.3 95 %CI 1.03−5.1) but not at 35 weeks when compared to 36 weeks, and among women receiving antenatal corticosteroids (OR 3.6 95 %CI 1.3−9.7), while antibiotic treatment showed a non-significant protective effect (OR 0.2 95 %CI 0.04−1.02). Prevalence of neonatal sepsis was 0.8 % (2/258) Conclusion: Expectant management of LpPROM should be encouraged especially between 34+0 and 34+6 weeks’, when the burden of prematurity is the greatest. Antibiotics may have beneficial effects, while careful consideration should be given to antenatal corticosteroids until future studies specifically address LpPROM. |
| Databáze: | OpenAIRE |
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