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J Perinatol. 2018 Aug;38(8):1087-1092. doi: 10.1038/s41372-018-0131-x. Epub 2018 May 22.

Outcomes of hypoxic respiratory failure at birth associated with previable rupture of membranes.

Baczynski M1, Ginty S1, Weisz D2,3, McNamara PJ3,4,5, Kelly E3,6, Shah PS3,6,7, Jain A8,9,10,11.

Author information

1
Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada.
2
Department of Newborn and Developmental Paediatrics, Sunnybrook Health Science Center, Toronto, ON, Canada.
3
Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
4
Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada.
5
Department of Physiology, University of Toronto, Toronto, ON, Canada.
6
Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
7
Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
8
Department of Paediatrics, University of Toronto, Toronto, ON, Canada. amish.jain@sinaihealthsystem.ca.
9
Department of Physiology, University of Toronto, Toronto, ON, Canada. amish.jain@sinaihealthsystem.ca.
10
Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada. amish.jain@sinaihealthsystem.ca.
11
Lunnenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. amish.jain@sinaihealthsystem.ca.

Abstract

OBJECTIVE:

To characterize clinical outcomes of infants born after previable rupture of membranes (pROM, < 23 weeks gestation and latency period ≥ 2 weeks) in relation to refractory hypoxic respiratory failure (rHRF).

STUDY DESIGN:

pROM neonates categorized as rHRF (FiO2 > 0.6 for ≥ 2 h) and treated (high frequency ventilation + inhaled nitric oxide) were compared with no rHRF group. Primary outcome was survival until discharge. Factors associated with rHRF and mortality were identified.

RESULT:

Overall, mortality and disability rates were 28% and 22%, respectively. Treated rHRF group (n = 32) had longer period of ROM, mortality was (31% vs. 14%; p = 0.20), with similar survival-without-disability (54% vs. 47%; p = 0.67). Higher gestational age at birth [1.57 (1.03,2.39)] and cesarean delivery [12.6 (1.22,125)] were associated with increased survival.

CONCLUSION:

Birth after pROM is associated with high rates of adverse outcomes, independent of latency period. Following treatment, rHRF infants may have similar long-term outcomes as those without rHRF.

PMID:
29785062
DOI:
10.1038/s41372-018-0131-x

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