Clinical observation of premature rupture of membranes and late-onset sepsis and (or) neonatal necrotizing enterocolitis in newborns

Abstract

Objective To investigate clinical manifestations of premature rupture of membranes (PROM) and late-onset sepsis (LOS) and (or) neonatal necrotizing enterocolitis (NEC), in order to provid theoretical basis for early identification and diagnosis of PROM and LOS and (or) NEC. Methods From June 2015 to June 2017, a total of 62 infants who were diagnosed as PROM and LOS, or PROM and NEC, or PROM and LOS and NEC in the First Affiliated Hospital of Anhui Medical University, were included as severe infection group. Meanwhile, another 62 neonates who were diagnosed as PROM without infectious diseases were included as control group. The following clinical items were retrospectively analyzed, including the general clinical data, such as days of visiting time, gender, delivery methods, and duration of membrane rupture, birth weight, gestational age at birth, and antenatal corticosteroid therapy, gestational diabetes mellitus, and gestational hypertension of the mothers. The differences between two groups in the aspects of days of visiting time and duration of membrane rupture were compared by Wilcoxon rank sum test, and the differences between two groups in the aspects of birth weight and gestational age at birth were compared by independent samples t-test. Furthermore, the differences between two groups in the aspects of constituent ratio of gender, constituent ratio of delivery method, and incidence of small for gestational age infant were compared by chi-square test. The relationship between days of the onset of LOS and (or) NEC and duration of membrane rupture of PROM pregnants was analyzed by Spearman rank correlation. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of First Affiliated Hospital of Anhui Medical University. Results ① There were no statistically significant differences between two groups in the aspects of days of visiting time, constituent ratio of gender and constituent ratio of delivery methods (P>0.05). ② The median duration of membrane rupture in severe infection group was 72 h (36-102 h), which was significantly longer than 48 h (18-72 h) in control group (Z=2.072, P=0.040). The birth weight in severe infection group and control group were (1 562.2±487.7) g and (1 967.6±582.8) g, respectively; and gestational age at birth in severe infection group and control group were (30.9±2.3) weeks and (32.9±2.5) weeks, respectively, there were significant differences between two groups in the aspects of birth weight and gestational age at birth (t=4.790, 5.172; P<0.001). Furthermore, the incidence of small for gestational age infants in severe infection group was 16.1% (10/62), which was significant higher than that of control group 3.2% (2/62), and the difference was statistically significant (χ2=5.905, P=0.015). ③ There was significant difference between severe infection group and the control group in constituent ratio of gestational age at birth (χ2=30.75, P=0.001). ④The onset of LOS and (or) NEC in severe infection group was 1-42 d, and the median was 13.5 d (9.8-18.0 d). There was a positive correction between the days of the onset of LOS and (or) NEC and duration of membrane rupture of PROM pregnants (rrank=0.327, P=0.009). Conclusions PROM and LOS and(or) NEC has a longer duration of membrane rupture, smaller gestational age at birth and higher incidence of small for gestational age infants. We should strengthen the focus on neonates with the duration of membrane rupture longer or equal than seventy-two hours, gestational age at birth less than thirty-four weeks and small for gestational age. Key words: Fetal membranes, premature rupture; Infection; Sepsis; Enterocolitis, necrotizing; Infant, newborn