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137: Outcomes in very low birthweight (VLBW) infants who delivered as a result of preterm rupture of the membranes (PPROM) versus preterm labor (PTL)

      Objective

      We sought to determine if there was a difference in outcomes in VLBW infants who delivered as a result of PTL versus pPROM.

      Study Design

      We included viable infants who delivered from 7/93 to 7/07 without congenital anomalies who weighed <1,500 grams from our neonatal database. Multiple gestations were excluded. pPROM was defined as documented preterm rupture of the membranes before the onset of labor. Univariate and multivariate analysis was performed.

      Results

      A total of 1260 neonates were included with 912 in the PTL group and 348 in the pPROM group. There was no difference in gestational age (27.4 v 27.6; p=0.35), birthweight (1035 v 1022 gms; p=0.47), race (41% v 45% caucasian; p= 0.2), primigravid status (26% v 32%; p=0.05), tobacco use (23% v 22%; p=0.95), and cesarean delivery (46% v 49%; p=0.31) between the pPROM and PTL groups. There was a higher rate of clinical chorioamnionitis (22% v 8%; p<0.01), antenatal steroid use (73% v 53%; p<0.01), and maternal antibiotic use (80% v 41%; p,0.01) in the pPROM group. There was a higher rate of antenatal magnesium sulfate exposure (37% v 19%; p<0.01), tocolytic use (42% v 27%; p <0.01) and SGA infants (10% v 3%; p<0.01) in the PTL group. Multivariate analysis controlling for potential confounders is presented in the table.
      Tabled 1Neonatal outcomes on multivariate analysis
      Adjusted OR with pPROM
      Death0.55 (0.34-0.9)
      Severe IVH0.67 (0.38-1.12)
      Severe IVH or Death0.65 (0.44-0.94)
      Chronic lung disease (CLD)0.77 (0.44-1.3)
      CLD and/or death0.56 (0.35-0.85)
      NEC0.98 (0.5-1.8)

      Conclusion

      VLBW infants who deliver as a result of pPROM have a lower death rate than those delivering after PTL.