Neonatal and early childhood outcomes following early vs later preterm premature rupture of membranes.
Neonatal and early childhood outcomes following early vs later preterm premature rupture of membranes.
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DOI：
10.1016/j.ajog.2014.05.030
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发表时间：
2014-09
影响因子：
9.8
通讯作者：
Varner, Michael Walter
中科院分区：
文献类型：
--
作者：
Manuck, Tracy Ann;Varner, Michael Walter
关于早期早产胎膜早破（PPROM;破膜时<25.0周）后新生儿存活的长期结局数据有限。我们假设早期PPROM后分娩的婴儿与晚期PPROM（破裂时≥25.0周）相比，儿童期主要发病率增加。这是一项硫酸镁与安慰剂预防脑瘫的多中心随机对照试验的次要分析。纳入了单胎和PPROM为15-32周的妇女。所有女性均在24.0周或更长时间分娩。PPROM小于25.0周的妇女（病例）与PPROM在25.0-31.9周的妇女（对照）进行比较。比较新生儿重度复合发病率（败血症、重度脑室内出血、脑室周围白质软化、重度坏死性小肠结肠炎、支气管肺发育不良和/或死亡）和2岁时重度儿童复合发病率（中度或重度脑瘫和/或Bayley II婴幼儿发育评分低于平均值2 SD以上）。共纳入1531名妇女（275例早期PPROM病例）。两组的人口统计学特征相似。分娩时间较早的病例（26.6 vs 30.1周，P < .001），破裂至分娩间隔较长（20.0 vs 10.4天，P < .001）。病例组新生儿重度综合发病率高（75.6%比21.8%，P <0.001）。早期PPROM儿童的复合重度儿童期发病率较高（51.6%比22.5%，P <0.001）。在多变量模型中，即使控制了分娩胎龄和其他混杂因素，早期PPROM仍与复合重度儿童期发病率相关。早期PPROM与高新生儿发病率相关。与晚期PPROM后分娩的儿童相比，2岁时的早期儿童结局仍然较差。
Data regarding long-term outcomes of neonates reaching viability following early preterm premature rupture of membranes (PPROM; <25.0 weeks at rupture) are limited. We hypothesized that babies delivered after early PPROM would have increased rates of major childhood morbidity compared with those with later PPROM (≥25.0 weeks at rupture). This was a secondary analysis of a multicenter randomized controlled trial of magnesium sulfate vs placebo for cerebral palsy prevention. Women with singletons and PPROM of 15-32 weeks were included. All women delivered at 24.0 weeks or longer. Those with PPROM less than 25.0 weeks (cases) were compared with women with PPROM at 25.0-31.9 weeks (controls). Composite severe neonatal morbidity (sepsis, severe intraventricular hemorrhage, periventricular leukomalacia, severe necrotizing enterocolitis, bronchopulmonary dysplasia, and/or death) and composite severe childhood morbidity at age 2 years (moderate or severe cerebral palsy and/or Bayley II Infant and Toddler Development scores greater than 2 SD below the mean) were compared. A total of 1531 women (275 early PPROM cases) were included. Demographics were similar between the groups. Cases delivered earlier (26.6 vs 30.1 weeks, P < .001) and had a longer rupture-to-delivery interval (20.0 vs 10.4 days, P < .001). Case neonates had high rates of severe composite neonatal morbidity (75.6% vs 21.8%, P < .001). Children with early PPROM had higher composite severe childhood morbidity (51.6% vs 22.5%, P < .001). Early PPROM remained associated with composite severe childhood morbidity in multivariable models, even when controlling for delivery gestational age and other confounders. Early PPROM is associated with high rates of neonatal morbidity. Early childhood outcomes at age 2 years remain poor compared with those delivered after later PPROM.
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作者：
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