Two-year neonatal outcome following PPROM prior to 25 weeks with a prolonged period of oligohydramnios O. Williams a, ⁎ , 1 , B. Michel a, 1 , G. Hutchings b , C. Debauche a , C. Hubinont b a Department of Neonatology, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Brussels, Belgium b Department of Obstetrics, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Brussels, Belgium abstract article info Article history: Received 15 November 2011 Received in revised form 18 January 2012 Accepted 28 January 2012 Keywords: Preterm rupture of membranes Oligohydramnios BPD Neurodevelopmental outcome Background: Improved neonatal survival data have been reported following early preterm prelabour rupture of membranes (PPROM) prior to 25 weeks gestation with a prolonged latency to delivery and persistent oli- gohydramnios. However, data regarding long-term respiratory and neurological morbidity are lacking. Aims: To evaluate the respiratory and neurological outcome data at two years of age in a cohort of infants born following PPROM prior to 25 weeks with a prolonged latency (14 days) to delivery and compare the data to an aged matched group of infants. Methods: Retrospective case note analysis over a 43-month period at Saint Luc University Hospital, Brussels. Results: 15 surviving infants born following PPROM were matched to a group of 30 control infants. Although there was no significant difference in the incidence of BPD between the groups (33% vs 27%, p = 0.24), the length of hospitalisation, duration of respiratory support and number of hospital readmissions for respiratory indications were all significantly higher for infants born following a prolonged period of oligohydramnios. There were no major anomalies on cranial ultrasound in the PPROM group and Baileys developmental assess- ment at 20–24 months corrected gestational age showed no difference between the two groups (Mental development index 93.9 vs 94.4 and Psychomotor development index 95.5 vs 95.8 respectively p = ns). Conclusion: Neurodevelopmental outcome appears encouraging in this cohort although these infants are at high risk of prolonged initial hospitalisation and significant respiratory morbidity in the first two-years of life. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Mid-trimester preterm prelabour rupture of the membranes (PPROM) is a complication which occurs in approximately 0.4–0.7% of pregnancies [1]. It is associated with a poor outcome due to the high risk of very preterm delivery and the risk of exposure to perina- tal infection and inflammation. Mid trimester PPROM may be fol- lowed by a prolonged latency to delivery and specific complications attributed to a sustained period of oligohydramnios include pulmo- nary insufficiency, musculoskeletal anomalies, and an increased risk of cord compression around the time of birth [2]. The optimal man- agement of pregnancies complicated by mid trimester rupture of membranes remains a challenge [3]. Whilst there is evidence regarding the benefit of the use of antenatal corticosteroids, the true risk–benefit ratio of other strategies aimed either at prolonging the pregnancy or restoring amniotic fluid volume remains unclear. Equally the optimal timing of delivery when the risk of prematurity is less than the risk of potential exposure to a harmful antenatal environment is unknown. Postnatal care is also controversial with no consensus regarding ventila- tion strategies and management of pulmonary hypertension in infants suffering from pulmonary hypoplasia. The use of specific therapies such as inhaled nitric oxide has been reported but value and the long- term outcome of this treatment needs to be clarified [4]. A number of clinical series published over the last decade have all shown a gradual improvement in neonatal survival to hospital dis- charge following pregnancies complicated by mid trimester PPROM. In the context of rupture prior to 25 weeks with a prolonged latency to delivery neonatal survival rates to hospital discharge are estimated to be around 70% [5–7]. Whilst survival to discharge rates appears to be encouraging, long term follow up is essential as it is possible that infants born following early PPROM with a prolonged latency to delivery are at higher risk of long-term neurodevelopmental and pulmonary sequelae than age matched preterm controls. The effects of exposure to antenatal inflam- mation and a high risk of chorioamnionitis preceding delivery are po- tentially deleterious to long-term outcome [8]. PPROM with a latency to delivery has also been identified as a risk factor for the development of cystic periventricular leukomalacia in preterm infants [9]. In addi- tion to this, the use of novel therapies, such as inhaled nitric oxide, in a preterm population requires a close attention to long-term outcome. Early Human Development 88 (2012) 657–661 ⁎ Corresponding author at: Department of Neonatology, 9th floor, Cliniques Univer- sitaires Saint Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium. Tel.: + 32 2 764 9108; fax: +32 2 764 91 72. E-mail address: olivia.williams@uclouvain.be (O. Williams). 1 Authors OW and BM contributed equally to the paper. 0378-3782/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.earlhumdev.2012.01.012 Contents lists available at SciVerse ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev