1441 ASSOCIATION OF CONGENITAL PNEUMONIA (CONPN) WITH SHORT DURATION OF RUPTURE OF MEMBRANES (ROM) IN VERY LOW BIRTHWEIGHT (VLBW) INFANTS

Abstract

Survey of 14,488 consecutive livebirths at the Grace Maternity Hospital, 1976-78, revealed that 52.3% of neonatal deaths occurred in 198 VLBW infants (500-1499g). Infection was the assigned cause of death in 20 of the 83 VLBW infants who died, of whom 12 had late onset disease and 8 had CONPN. One infant died of HMD with CONPN. Fifty-two VLBW infants had ROM>24 hr, of whom none was identified as having intrauterine infection. Of 5 infants with unknown ROM, 1 had CONPN. Of 141 infants with ROM < 24hr, 8 had CONPN all of whom had ROM <8hr. The 9 VLBW infants with CONPN died with the diagnosis confirmed at autopsy. All 9 placentae demonstrated chorioamnionitis and 7 funisitis. All 9 infants were severely depressed at birth and died by 31 hr of age, 7 by 5 hr. E Coli, Listeria and Group B Strep were implicated in 3 infants, but no organisms were isolated in 6. The 9 infants with CONPN had a lower mean birthweight than VLBW infants without CONPN (794 ± 175 g S.D. vs 1116 ± 266 g, p<0.001) and a lower gestational age (25.5 ± 2.0 wk vs 29.4 ± 3.5 wk, p<0.001) where this was known. When ROM was known, the 8 infants with CONPN had a shorter duration of ROM than infants without CONPN (3.0 ± 3,3 hr vs 54.2 ± 135.2 hr, p <0.001). We speculate that intrauterine infection in the absence of ruptured membranes led to premature labour and delivery in these VLBW infants with congenital pneumonia.