Short-term outcomes comparison between preterm infants with and without acute hypoxic respiratory failure attributable to presumed pulmonary hypoplasia after prolonged preterm premature rupture of membranes before 25 gestational weeks

Abstract

Objective: To determine the updated outcomes of preterm infants with acute hypoxic respiratory failure attributable to presumed pulmonary hypoplasia (PH) following maternal midtrimester prolonged preterm premature rupture of membranes (PPROM). Study design: Among preterm infants with birthweight <1500 g and 23-34 weeks gestational age in a single center, infants exposed to maternal prolonged (>= 7 days) PPROM before 25 gestational weeks (PPPROM25, n = 76) were retrospectively reviewed. They were 1:1 matched with infants of matched control group (n = 76) who were unexposed to or exposed to maternal PPROM within 24 hours of delivery by year, gestational age, and weight at birth, sex, and antenatal steroid exposure. The PPPROM25 group was subdivided into infants with and without acute hypoxic respiratory failure attributable to PH (with PH, n = 20, without PH, n = 56, respectively). Clinical characteristics and major outcomes were compared. Risk factors for mortality and morbidity were analyzed using a multivariate logistic regression in the PPPROM25 group. Results: The PH incidence rates were 1.3 and 26.3% and in the matched control and PPPROM25 group, respectively (p < .05). The survival rates were 92.1 and 81.6% in the matched control and PPPROM25 group (p > .05); 87.5 in the PPPROM25 group without PH and 65.0% in group with PH, respectively (p < .05). While there were no significant differences between matched control and PPROM25 group, the PPROM25 with PH group had a significantly higher rate of periventricular leukomalacia (PVL) and composite morbidity, including mortality, bronchopulmonary dysplasia, high-grade intraventricular hemorrhage, and PVL than PPPROM25 without PH group. PH was a significant risk factor for mortality and composite morbidity in the PPPROM25 group. Conclusions: Despite the improved outcomes in the infants with maternal prolonged PPROM before 25 gestational weeks, presumed PH is still a significant risk factor for their mortality and morbidity.