Neonatal Mortality and Morbidity after Aggressive Long-Term Tocolysis for Preterm Premature Rupture of the Membranes

• Published in: Fetal diagnosis and therapy Vol. 21; no. 4; pp. 366 - 373
• Main Authors: Wolfensberger, Aline, Zimmermann, Roland, von Mandach, Ursula
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2006; S. Karger AG
• Subjects: Adult; Biological and medical sciences; Cohort Studies; Diseases of mother, fetus and pregnancy; Female; Fetal Membranes, Premature Rupture - therapy; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Infant Mortality; Infant, Newborn; Logistic Models; Management. Prenatal diagnosis; Medical sciences; Morbidity; Pregnancy; Pregnancy. Fetus. Placenta; Retrospective Studies; Time Factors; Tocolysis - adverse effects; Mortality and morbidity, predischarge neonatal; Neonatal intensive care; Prematurity; Preterm premature rupture of membranes; Tocolysis; Human; Neonatal; Intensive care; Pregnancy disorders; Prenatal Diagnosis; Mortality; Premature rupture of membrane; Epidemiology; Long term; Morbidity; Newborn; Mortality and morbidity; predischarge neonatal; Delivery disorders; High malignancy
• ISSN: 1015-3837; 1421-9964
• DOI: 10.1159/000092467

Objective: To test the hypothesis that predischarge morbidity and mortality are not increased for infants admitted to our neonatal intensive care unit and whose mothers had tocolysis for >48 h plus antibiotics and steroids (aggressive long-term tocolysis) after preterm premature rupture of the membranes (PPROM) as compared with gestational age-matched infants born to mothers not treated for PPROM. Methods: A retrospective cohort study was conducted on live preterm births (≤36.0 weeks) admitted to the neonatal intensive care unit between January 1, 1999 and June 30, 2003, comparing singletons born to mothers with PPROM + tocolysis for >48 h (n = 137, group 1) with singletons born to all other mothers matched for group-1 gestational age at delivery (n = 628, group 2), excluding severe maternal complications such as insulin-dependent diabetes and preeclampsia in both groups. Primary outcome was the predischarge mortality and morbidity of the neonates. Results: In the group with post-PPROM tocolysis which lasted for 14.4 ± 14.0 days with a latency of 15.3 ± 15.3 days (time from PPROM to delivery) and 14.4 ± 14.0 days (time from the start of tocolysis to delivery), the predischarge mortality and morbidity was not increased compared to the non-treated group. The 1- and 10-min Apgar scores of between 1 and 7 were less frequent with tocolysis (p < 0.05), and oxygen use was less frequent (26.3 vs. 36.3%, p = 0.03) and shorter (8.7 vs. 19.6 days, p = 0.03). However, amniotic fluid infection syndrome and latency (i.e. >1 week) are the most potential predictors of the respiratory distress syndrome in addition to gestational age at delivery in pregnancies with post-PPROM tocolysis. Conclusions: Amniotic fluid infection syndrome and a latency of >1 week achieved by aggressive post-PPROM tocolysis lessens the advantages of extended gestational age and decreased predischarge neonatal morbidity. These findings may have important implications for the clinical management of PPROM.