P16.21: Fetal weight and neonatal outcomes in pre‐viable rupture of membranes

Abstract

The aim of this study was to identify the adverse neonatal outcomes, with an emphasis on mortality, morbidity (considered here as pulmonary hypoplasia, ROP, PVL and PIH) and morbimortality, and to analyze fetal weight as a predictors of adverse neonatal outcomes in pre-viable premature rupture of membranes. Data were collected between January, 2005 and December, 2011 from all of the pregnant women who presented premature rupture of membranes (PROM) between 18 and 26 complete weeks and who were admitted to one of three Brazilian institutes. The adverse outcomes included mortality or the development of a severe morbidity during the lengh of stay in the neonatal intensive care unit (NICU). The descriptive statistics of the population were reported. A multiple logistic regression was performed for fetal weight of neonatal adverse outcomes. The area under the receiver operating characteristics curves for the fetal weight was calculated. Adverse outcomes during the NICU stay occurred in 82.1% (n = 23) of the cases and included 33 (54%) deaths, 19 (67.8%) cases of retinopathy of prematurity (ROP), 13 (46.4%) cases of pulmonary hypoplasia (BPD), 8 (28.5%) cases of periventricular-intraventricular hemorrhage (PIH) and 3 (10.7%) cases of periventricular leukomalacia (PVL). Only 17.8% (n = 5) of the neonates survived without morbidity. The area under the curve for the fetal weight was 0,90 (95% IC: 0.81-0.98) for the prediction of mortality. Fetal weight was identified as an important predictor of neonatal outcome, leading us to conclude that when we choose conservative management for a pre-viable PROM pregnancy, all of the efforts should be focused on prolonging the latency period (for example, through the use of antibiotic prophylaxis) and increasing the birthweight. However, it should be noted that the fetal weight only influences the neonatal mortality and not the morbidity, which remains a concern for these neonates.