The impact of premature rupture of membrane on neonatal outcomes in infants born at 34 weeks gestation or later

Abstract

Background: Premature rupture of membranes (PROM) is a known risk for adverse neonatal outcomes, often leading to neonatal hospitalization due to suspected perinatal infection or other issues. This study assesses PROM's clinical impact on neonatal outcomes in infants born at 34 weeks of gestation or later. Methods: We studied hospitalized neonates born between December 2018 and November 2019, with gestational ages of 34 weeks or more and PROM diagnosis. We extracted patient data from clinical records, including demographics, maternal history, medical profiles, and neonatal outcomes. Neonates were categorized based on symptoms, PROM duration, neonatal intensive care unit (NICU) stay, and respiratory support. Data underwent thematic analysis. Results: Of 275 neonates, the average PROM duration was 7.9 ± 8.1 hours, with 247 cases (89.8%) showing symptoms. Among them, 34 (12.4%) had PROM lasting over 18 hours, 48 (17.5%) were born prematurely, and 79 (28.7%) required intensive care. Symptomatic neonates had significantly higher rates of needing intensive care, respiratory support, prolonged antibiotics, and extended hospitalization (p < 0.05). NICU stays (≥ 3 days) were significantly associated with prematurity (Odds ratio [OR] = 5.49; 95% confidence interval [CI]: 2.39-12.60) and an initial pH level < 7.25 (OR = 3.35; 95% CI: 1.46-7.68). Extended respiratory support (≥ 3 days) was significantly correlated with tocolysis ≥ 7 days (OR = 13.20; 95% CI: 3.94-44.20), Apgar score < 7 at 1 minute after birth (OR = 4.28; 95% CI: 1.67-10.97), and inadequate intrapartum antibiotic prophylaxis (IAP) (OR = 2.34; 95% CI: 1.04-5.23). Conclusion: Neonates born at or after 34 weeks of gestation with PROM should undergo vigilant monitoring if early symptoms (< 24 hours) manifest. Risk factors for requiring NICU care or extended respiratory support (≥ 3 days) include prematurity, low initial pH (< 7.25), prolonged tocolysis requirement (≥ 7 days), an Apgar score below 7 at 1 minute, and inadequate IAP.