TOPLINE

Among infants who survived preterm prelabor rupture of membranes (pPROM) before 23 weeks and received active neonatal care, more than 70% survived without moderate or severe neurodevelopmental impairment at 2–3 years. Neonatal morbidity burden was more closely associated with later neurodevelopment than gestational age at membrane rupture or latency duration.

METHODOLOGY

• Researchers conducted a retrospective study of 109 infants with pPROM before 23 weeks' gestation who received active neonatal care between 2009 and 2022 in Austria.
• Of all infants, 33 infants died before discharge and neurodevelopmental outcome data at 24-36 months' corrected age were available for 63 (82.9%) of 76 survivors.
• Mean gestational age was 21.6 weeks at membrane rupture and 25.7 weeks at delivery, with median latency of 26 days and mean birth weight of 814 g.
• Primary outcome was neurodevelopmental assessment using Bayley Scales of Infant Development, third edition (Bayley-III), with cerebral palsy (CP) classified according to the Gross Motor Function Classification System (GMFCS).
• Moderate or severe neurodevelopmental impairment was defined as Bayley-III cognitive score < 70, CP GMFCS level II-V, bilateral blindness, or severe hearing loss; and severe neurodevelopmental impairment was defined as cognitive score < 55, CP GMFCS level IV-V, bilateral blindness, or severe hearing loss.

TAKEAWAY

• Median Bayley-III scores were 90 for cognition, 81 for language, and 89 for motor function, with CP occurred in 11.1% of survivors.
• Survival without moderate or severe neurodevelopmental impairment was 72.6%, moderate neurodevelopmental impairment occurred in 11.0%, and severe neurodevelopmental impairment in 16.4%.
• Latency duration and gestational age at rupture were not significantly associated with neurodevelopmental outcome among survivors.
• Infants without severe neonatal morbidity had higher rates of survival without moderate or severe neurodevelopmental impairment than those with severe morbidity (89.7% vs 57.6%); morbidity burden was independently associated with outcome (OR, 0.39; P = .025).

IN PRACTICE

"In this cohort of infants with previable pPROM receiving active neonatal care, a substantial proportion of survivors achieved favorable neurodevelopmental outcomes at 2-3 years," the authors wrote. "These findings highlight the importance of considering the postnatal clinical course in addition to antenatal characteristics when counselling families at the limit of viability."

SOURCE

The study was led by Agnes Grill, Division of Neonatology, Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria. It was published online on July 30 in European Journal of Pediatrics.

LIMITATIONS

The study was limited by single-center design, small sample size, survivor-only analysis, and loss to follow-up. The study included only infants who received active neonatal care, excluding pregnancies ending in stillbirth or managed with compassionate care, representing a highly selected population.

DISCLOSURES

The study was supported by the Medical University of Vienna. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.