PROLONGED PREMATURE RUPTURE OF MEMBRANES IN THE PRETERM INFANT - A 7-YEAR STUDY

Aim: to review the outcome of infants born following prolonged and preterm rupture of the membranes. Design: retrospective and partially prospective observational study. Setting: babies born in and referred to a tertiary neonatal centre. Patients: 117 preterm infants, median gestation (range) = 29.5 (25-36) weeks, seen over a 7 year period with membranes ruptured for more than 4 days; median (range) = 9 (4-119) days. Outcome measures: survival and cause of death, compression deformities, pulmonary hypoplasia and infection. Results: 23 infants died, 11 from pulmonary hypoplasia and 11 as a direct consequence of prematurity (3 from hyaline membrane disease, 7 from bronchopulmonary dysplasia and one from necrotising enterocolitis developed on day 17). One infant had a lethal congenital abnormality and died untreated of overwhelming infection. No other infants died of infection. 94% of infants were treated with broad-spectrum antibiotics after birth. Compression deformities were seen in 25 infants: median duration of membrane rupture 28 days, range 4-119. In those without deformity, median duration was 7 days, range 4-105. Sixteen infants had pulmonary hypoplasia (median 31, range 14-119), 11 died (median 37, range 21-112) and five survived (median 23, range 14-119). Although the median duration of membrane rupture in infants dying of pulmonary hypoplasia was longer than in those who did nit hav hypoplasia (31 compared to 7 days), 13 of 27 (48%) of infants whos membranes were ruptured for 4 weeks and 4 of 7 (57%) whose membranes were ruptured more than 70 days survived. Conclusion: death from pulmonary hypoplasia is a much more serious problem following preterm prolonged membrane rupture than is infection. Pulmonary hypoplasia is not inevitable even after prolonged periods of membrane rupture.