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Neonatal Follow-up

NICU Follow Up and Neurodevelopment 3: Impact of the Prenatal Environment on Development and Outcomes

226 - Neurodevelopmental outcomes following preterm prelabour rupture of membranes versus spontaneous preterm birth among infants born at <29 weeks’ gestation

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 226
Publication Number: 226.143

M, Florencia Ricci, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Christy Pylypjuk, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Diane Moddemann, University of Manitoba, Winnipeg, MB, Canada; Ayman Abou Mehrem, University of Calgary, Calgary, AB, Canada; Lindsay Richter, University of British Columbia, Vancouver, BC, Canada; Jill G. Zwicker, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Prakesh S. Shah, Mount Sinai Hospital, Toronto, ON, Canada

Presenting Author(s)

DEEPAK LOUIS, MD, DM (he/him/his)

Assistant Professor
Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
Winnipeg, Manitoba, Canada

Co-Author(s)

MR

M. Florencia Ricci, MD. PhD (she/her/hers)

Developmental Pediatrician
Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
University of Manitoba
Winnipeg, Manitoba, Canada

Background:

Few studies have examined the differences in neurodevelopmental outcomes between spontaneous preterm birth (sPTB) and those additionally complicated by preterm prelabour rupture of membranes (PPROM).

Objective:

To compare mortality and neurodevelopmental outcomes at 18-30 months corrected age following PPROM versus sPTB among infants < 29 weeks of gestation born in Canada between 2010-2018, and to compare neurodevelopmental outcomes between those with PPROM 1-7 days, >7days, and sPTB.

Design/Methods:

This is a historical cohort study from the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network. PPROM was defined as rupture of membranes for ≥ 24 hours. The time interval between rupture of membranes and time of birth was divided as PPROM 1-7 days or >7days. Developmental outcomes at 18-30 months corrected age included Bayley-III scores < 70 or < 85, hearing/vision loss and cerebral palsy. Differences in maternal-infant characteristics and neonatal morbidities were assessed by Chi-square and Student t-tests. Crude and adjusted odds ratios (OR) with 95% CIs were calculated.

Results:

Study population included 4271 children, 1503 (35%) PPROM, 2768 (65%) sPTB. When compared to the PPROM group, the sPTB group had a statistically significant higher proportion of maternal nulliparity, maternal hypertension and outborn infants, as well as a lower proportion of maternal gestational diabetes and antenatal steroids administration. In the neonatal period, PPROM neonates had lower rates of ROP and severe neurologic injury. Crude OR comparing PPROM vs. sPTB showed decreased mortality (OR: 0.75 (0.65, 0.87)), decreased total cerebral palsy rates (OR: 0.57 (0.41, 0.80).

Conclusion(s):

Among preterm infants born < 29 weeks’ gestation, PPROM 1-7 days prior to birth was associated with lower odds of mortality and non-ambulatory CP at 18-30 months corrected age when compared to neonates born following sPTB. We speculate this may be related to maternal/fetal surveillance in PPROM cases; however, when PPROM is prolonged then potential inflammatory state may be deleterious.