463: Chorioamnionitis, neonatal sepsis and cerebral palsy or death in PROM

Abstract

Expectant management (EM) of PPROM increases the risk of chorioamnionitis (CA) and adverse fetal/ neonatal outcomes and cerebral palsy (CP). Prior studies reported increased risk of CP in association with CA and/or neonatal sepsis (NS). Risks were reported prior to universal use of steroids (CS), latency antibiotics (LA) and magnesium sulfate (MG). Our objectives are 1) determine the rate of CA, fetal/neonatal death (FND), NS and CP or death by gestational age (GA) at rupture, and 2) evaluate whether the presence of CA or NS is associated with CP or death in the era of universal use of CS, LA and MG. Secondary analysis from a multicenter trial of MG for prevention of CP. Women with singleton PROM < 32 wk (n = 1760) receiving universal CS and LA were studied. Rates and clinical risk factors for CA, FND, NS and CP or death at rupture were evaluated. CA was diagnosed in 221 (13%), FND in 135 (8%), NS in 276 (16%) and CP or death in 166 (10%). NS was significantly higher in CA as compared to control (22% vs 15%, P < 0.001). Table describes the outcomes by GA at rupture. The rate of serious complications was inversely related to GA at rupture. Multivariate analysis revealed that GA at PROM (aOR 0.67: 95 CI, 0.62-0.73) and latency period (aOR 0.97: 95 CI, 0.96-0.98) were associated with CP death. Neither CA (aOR 1.21: 95 CI, 0.74-1.98) nor NS (aOR 1.34: 95 CI, 0.91-1.99) were associated with CP or death. There was no association between CA and any CP (aOR 1.1: 95 CI, 0.57-2.3). In the era of universal use of steroids, latency antibiotics, magnesium sulfate, and expectant management of PROM < 32 wks, the rate of clinical chorioamnionitis was 13% and inversely associated with GA at rupture. Our findings do not support the prior literature regarding the association of clinical chorioamnionitis with CP in preterm births. We speculate this may be due to differences in current treatment regimens for preterm PROM compared to prior studies.Tabled 1Serious perinatal and long term infant outcomes*Clinical Chorioamnionitis; **Culture-proven neonatal sepsis; ***Moderate or severe cerebral palsy at or beyond 2 years of corrected age. Infant death at 1 year of corrected age. Open table in a new tab