Objective: ACOG suggests expectant management until 34 weeks for patients with PPROM. New data suggests extending to 37 weeks might enhance neonatal outcomes, reducing prematurity-linked issues. This study aims to assess adverse neonatal outcomes across gestational ages in women with PPROM.
Study design: A retrospective cohort study was performed using linked vital statistics and ICD-9 data. Gestational age at delivery ranged from 32 to 36 weeks. Outcomes include NICU admission >24 hours, neonatal sepsis, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Multivariate regression analyses and chi-squared tests were employed for statistical comparisons.
Results: In this cohort of 28,891 deliveries, there was a statistically significant decline in all studied adverse neonatal outcomes with increasing gestational age, without an increase in neonatal sepsis. At 32 weeks, 93% of newborns were in the NICU >24 hours compared to 81% at 34 weeks and 22% at 36 weeks (p<0.001). At 32 weeks, 20% had neonatal sepsis compared to 11% at 34 weeks and 3% at 36 weeks (p<0.001). At 32 weeks, 67% had RDS compared to 44% at 34 weeks and 12% at 36 weeks (p<0.001).
Conclusion: In the setting of PPROM, later gestational age at delivery is associated with decreased rates of adverse neonatal outcomes without an increase in neonatal sepsis.
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