Prolonged latency of preterm prelabour rupture of membranes and neurodevelopmental outcomes: a secondary analysis

ObjectiveTo determine whether prolonged latency after preterm prelabour rupture of membranes (PPROM) is associated withan increased risk for adverse neurodevelopmental outcomes. DesignThis is a secondary analysis of the randomised controlled trial of magnesium sulphate for the prevention of cerebral palsy. SettingMulticentre trial. PopulationA total of 1305 women with PPROM were analysed, 1056 of whom had an interval of <3weeks between diagnosis and delivery and 249 of whom had an interval of 3weeks between diagnosis and delivery. MethodsWe evaluated whether the time interval between diagnosis of PPROM and delivery was associated with an increased risk for adverse neurodevelopmental outcomes. Latency was analysed as a continuous variable and categorised by weeks of latency. Main outcome measuresThe primary outcome was motor and mental Bayley scores of <70 at 2years of age. Secondary outcomes included motor and mental Bayley scores <85 and mean Bayley scores. Logistic regression was used to control for confounding factors. ResultsIn the univariate analysis, motor and mental Bayley scores of <70 were similar in the <3weeks (16.8 and 14.4%) and 3weeks (15.3 and 14.1%) groups. In the regression analysis adjusting for confounding factors, PPROM for 3weeks was an independent risk factor for motor (adjusted odds ratio (aOR)2.12; 95%confidence interval, 95%CI 1.29-3.49) and mental (aOR1.83, 95%CI 1.13-3.00) Bayley scores of <70. Neonatal sepsis, gestational age at delivery, maternal education, and race were significantly associated with neurodevelopmental outcomes. ConclusionsWhereas delivery at later gestational age is associated with improved prognosis for many outcomes, prolonged exposure to an intrauterine environment of PPROM is an independent risk factor for adverse neurodevelopmental outcomes. Tweetable abstractProlonged PPROM was associated with motor and mental Bayley scores of <70. Tweetable abstract Prolonged PPROM was associated with motor and mental Bayley scores of <70.