Is it Possible to Make a Reliable Prognosis within the First Hour of Life for Very Low Birth Weight Infants Delivered after Preterm Premature Rupture of Membranes?

Neonatology - Tập 99 Số 2 - Trang 146-152 - 2011
A. Messerschmidt1, Monika Olischar2, Robert Birnbacher3, Alexandra Sauer1, Michael Weber4, D. Puschnig1, Christian Popow1, Arnold Pollak1, Harald Leitich5
1Division of General Pediatrics and Neonatology, Department of Pediatrics and Adolescent Medicine,
2Department of Neonatology, The Royal Children's Hospital, Melbourne, Vic., Australia
3Department of Pediatrics, Hospital of Villach, Villach, Austria
4Department of Radiology, and,
5Department of Obstetrics and Maternal-Fetal Medicine, Medical University of Vienna, Vienna, and

Tóm tắt

<i>Background:</i> One third of all preterm births are due to preterm premature rupture of membranes (pPROM). An accurate prognostic evaluation after admission to the neonatal intensive care unit is necessary. <i>Objective:</i> The aim of this study was to identify prognostic factors within the first hour of life for mortality, short-term pulmonary morbidity, chronic lung disease (CLD) and severe cerebral morbidity in very low birth weight (VLBW) infants after pPROM. <i>Methods:</i> This retrospective study included 300 infants with pPROM who fit the study criteria and were derived from a cohort of 1,435 VLBW infants. A total of 17 obstetric and neonatal factors were evaluated by univariate and multivariate analysis. <i>Results:</i> Gestational age at birth and 5-min Apgar score correlated significantly with all 4 outcomes. The results of the first blood gas analysis correlated with 3 outcomes and the first mean arterial pressure with 2 outcomes. Anhydramnios and a lower number of courses of antenatal steroids correlated with higher mortality, and preterm labor correlated with CLD. The multivariate analysis revealed gestational age, 5-min Apgar score, the results of the first blood gas analysis, the first mean arterial pressure and anhydramnios to be significant predictors. The positive predictive value ranged from 20 to 81%, and the negative predictive value ranged from 79 to 92%. <i>Conclusion:</i> Gestational age at birth and parameters reflecting postnatal adaptation were the most precise factors for assessment of the prognosis of VLBW infants after pPROM within the first hour of life. Apart from anhydramnios, obstetric factors did not predict neonatal outcome. At 1 h of age, our models of perinatal risk factors were more effective in predicting a favorable outcome than an adverse outcome.

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Neonatology

Tập 99 Số 2

146-152

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