Outcomes of Extremely Preterm Infants Exposed to Prolonged Prelabor Rupture of Membranes before 24 Weeks of Gestation.

Background: Preterm prelabor rupture of membranes (PPROM) before or around the limit of fetal viability is associated with serious maternal and neonatal complications including chorioamnionitis, extremely preterm birth, and pulmonary hypoplasia.

Objectives: To describe contemporary outcomes of extremely preterm infants born after prolonged periviable PPROM, and to identify perinatal factors associated with survival and survival without severe neurodevelopmental impairment (NDI).

Study design: Among actively treated infants born alive at <27 weeks' gestational age (GA) in centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network from 2012 to 2018, the outcomes of survival and survival without severe NDI at 22-26 months' corrected age were compared between infants exposed to prolonged (≥120 hours) periviable (<24 weeks' GA) PPROM and unexposed infants born after rupture of membranes ≤18 hours before delivery or at delivery, adjusting for birth GA, sex, multiple gestation, antenatal steroids, small for gestational age (SGA), insurance, and center. Regression models were used to identify perinatal factors associated with survival and survival without severe NDI among the infants exposed to prolonged periviable PPROM.

Results: The analysis included 609 infants exposed to prolonged periviable PPROM and 4,489 unexposed infants. In the prolonged periviable PPROM group, 444/608 (73%) infants survived and 298/533 (56%) infants survived without severe NDI. Odds of survival (OR, 0.84; 95% CI, 0.68-1.05) and survival without severe NDI (OR, 0.91; 95% CI, 0.75-1.12) were not significantly different between prolonged periviable PPROM and unexposed groups. Variables associated with higher odds of survival without severe NDI were later GA at birth (OR, 1.37; 95% CI, 1.13-1.67), later GA at PPROM (OR 1.44; 95% CI, 1.26-1.63), and female sex (OR, 1.57; 95% CI, 1.06-2.34), while SGA infants had lower odds of survival without severe NDI (OR, 0.14; 95% CI, 0.04-0.51).

Conclusions: Odds of survival and survival without severe NDI among infants exposed to prolonged periviable PPROM were not significantly different from unexposed infants, but decreased with earlier GA at birth and PPROM.