Birthweight Extremes and Neonatal and Childhood Outcomes after Preterm Premature Rupture of Membranes

Abstract

Objective To determine the association between birthweight extremes and risk of adverse neonatal and childhood outcomes following preterm premature rupture of membranes (PPROM).

Study Design This is a secondary analysis of data from the Beneficial Effects of Antenatal Magnesium Sulfate Trial. Women with nonanomalous singletons and PPROM delivering ≥24.0 weeks were included. Birthweight was classified as small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age (LGA). Composite severe neonatal morbidity and childhood outcomes at age 2, were compared between these groups.

Results One thousand five hundred and ninety-eight infants were included (58 SGA, 1,354 AGA, and 186 LGA). There was an inverse relationship between birthweight and rate of composite major neonatal morbidity (55.2% of SGA, 31.5% of AGA, 18.3% of LGA, p < 0.001). Former-SGA children were more likely to be diagnosed with major composite childhood morbidity at age 2 (25.9% of SGA, 8.3% of AGA, 5.9% of LGA, p < 0.001). In multivariate models, LGA infants had improved initial neonatal outcomes compared with AGA infants (adjusted odds ratio [aOR], 0.44; 95% confidence interval [CI], 0.28–0.71; p = 0.001).

Conclusion Among infants delivered following PPROM, those who were LGA at delivery had improved composite adverse neonatal outcomes. SGA increases the risk of severe neonatal morbidity, early childhood death, and moderate/severe cerebral palsy at age 2.

Keywords

small for gestational age - large for gestational age - preterm premature rupture of membranes - neonatal morbidity - childhood morbidity

Note

This study was presented, in part, in poster format at the 34th annual meeting of the Society for Maternal-Fetal Medicine, New Orleans, LA, February 3 to 8, 2014.

• References

• 1 Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 2005; 32 (3) 411-428
• 2 Ananth CV, Oyelese Y, Srinivas N, Yeo L, Vintzileos AM. Preterm premature rupture of membranes, intrauterine infection, and oligohydramnios: risk factors for placental abruption. Obstet Gynecol 2004; 104 (1) 71-77
• 3 Garite TJ, Freeman RK. Chorioamnionitis in the preterm gestation. Obstet Gynecol 1982; 59 (5) 539-545
• 4 Mercer BM, Miodovnik M, Thurnau GR , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. JAMA 1997; 278 (12) 989-995
• 5 Practice bulletins No. 139: premature rupture of membranes. Obstet Gynecol 2013; 122 (4) 918-930
• 6 Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; (3) CD004454
• 7 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3) 443-456
• 8 Eichenwald EC, Stark AR. Management and outcomes of very low birth weight. N Engl J Med 2008; 358 (16) 1700-1711
• 9 Tyson JE, Parikh NA, Langer J, Green C, Higgins RD ; National Institute of Child Health and Human Development Neonatal Research Network. Intensive care for extreme prematurity—moving beyond gestational age. N Engl J Med 2008; 358 (16) 1672-1681
• 10 Raju TN, Mercer BM, Burchfield DJ, Joseph Jr GF. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2014; 210 (5) 406-417
• 11 Rysavy MA, Li L, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19) 1801-1811
• 12 Rouse DJ, Hirtz DG, Thom E , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (9) 895-905
• 13 Carey JC, Klebanoff MA, Hauth JC , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342 (8) 534-540
• 14 Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (2) e214-e224
• 15 Cuzick J. A Wilcoxon-type test for trend. Stat Med 1985; 4 (1) 87-90
• 16 Murray E, Fernandes M, Fazel M, Kennedy SH, Villar J, Stein A. Differential effect of intrauterine growth restriction on childhood neurodevelopment: a systematic review. BJOG 2015; 122 (8) 1062-1072
• 17 Levine TA, Grunau RE, McAuliffe FM, Pinnamaneni R, Foran A, Alderdice FA. Early childhood neurodevelopment after intrauterine growth restriction: a systematic review. Pediatrics 2015; 135 (1) 126-141
• 18 von Beckerath AK, Kollmann M, Rotky-Fast C, Karpf E, Lang U, Klaritsch P. Perinatal complications and long-term neurodevelopmental outcome of infants with intrauterine growth restriction. Am J Obstet Gynecol 2013; 208 (2) 130.e1-130.e6
• 19 García B, Llurba E, Valle L , et al. Do knowledge of uterine artery resistance in the second trimester and targeted surveillance improve maternal and perinatal outcome? UTOPIA study: a randomized controlled trial. Ultrasound Obstet Gynecol 2016; 47 (6) 680-689
• 20 Gomez-Roig MD, Mazarico E, Sabria J, Parra J, Oton L, Vela A. Use of placental growth factor and uterine artery doppler pulsatility index in pregnancies involving intrauterine fetal growth restriction or preeclampsia to predict perinatal outcomes. Gynecol Obstet Invest 2015; 80 (2) 99-105
• 21 Buetow KC, Klein SW. Effect of Maintenance of “Normal” Skin Temperature on Survival of Infants of Low Birth Weight. Pediatrics 1964; 34: 163-170
• 22 Day RL, Caliguiri L, Kamenski C, Ehrlich F. Body Temperature and Survival of Premature Infants. Pediatrics 1964; 34: 171-181
• 23 Bukowski R, Gahn D, Denning J, Saade G. Impairment of growth in fetuses destined to deliver preterm. Am J Obstet Gynecol 2001; 185 (2) 463-467
• 24 Hediger ML, Scholl TO, Schall JI, Miller LW, Fischer RL. Fetal growth and the etiology of preterm delivery. Obstet Gynecol 1995; 85 (2) 175-182
• 25 Morgan TK, Tolosa JE, Mele L , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Placental villous hypermaturation is associated with idiopathic preterm birth. J Matern Fetal Neonatal Med 2013; 26 (7) 647-653
• 26 Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM. Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: associated placental pathologic features. Am J Obstet Gynecol 1995; 173 (4) 1049-1057
• 27 Hanke K, Hartz A, Manz M , et al; German Neonatal Network (GNN). Preterm prelabor rupture of membranes and outcome of very-low-birth-weight infants in the German Neonatal Network. PLoS ONE 2015; 10 (4) e0122564
• 28 Lampl M, Kusanovic JP, Erez O , et al. Early rapid growth, early birth: accelerated fetal growth and spontaneous late preterm birth. Am J Hum Biol 2009; 21 (2) 141-150