Rupture of membranes and short-term respiratory outcomes in extremely preterm infants: a multicenter retrospective cohort study

Abstract

BackgroundWe aimed to describe the epidemiology and outcomes of preterm premature rupture of membranes (PPROM) in extremely preterm infants, and to analyze the impact of the timing of rupture of membranes (ROM) on survival and short-term respiratory outcomes.MethodsObservational, multi-center cohort study, including extremely preterm infants born between 23 + 0 and 27 + 6 weeks. Gestational age at ROM and time interval from ROM to birth were the main exposure variables, the primary outcome was survival without BPD.ResultsThe study included 4954 infants, median gestational age was 26 weeks (IQR 25-27). Overall, 1974 infants (37.1%) had rupture of membranes 24 or more hours prior to delivery. Higher gestational age at ROM was associated with increased survival (aOR 1.10, 95%CI 1.05-1.16), increased survival without BPD (aOR 1.11, 95%CI 1.04-1.20), and decreased risk of pneumothorax (aOR 0.91, 95%CI 0.84-0.97). Longer time from ROM to delivery was associated with decreased survival (aOR 0.92, 95%CI 0.87-0.96), decreased survival without BPD (aOR 0.89, 95% CI 0.83-0.96), and pneumothorax (aOR 1.07, 95%CI 1.02-1.12).ConclusionEarlier timing of rupture of membranes and longer interval between ROM and birth impact survival and survival without BPD. Both factors should be considered when counseling families at risk of preterm birth.ImpactThe timing of ROM has an impact on short term outcomes and respiratory morbidity in extremely preterm infants, and it should be taken into consideration when counseling families.This large, multicentre study including over 4954 infants provides real-world data on how earlier gestational age at ROM and prolonged latency to delivery are associated with worse outcomes in extremely preterm infants.The findings have important clinical implications for perinatal decision-making and family counseling, helping shape individualized risk assessments and guide perinatal interventions.