[Is previable rupture of membranes an independent neonatal prognostic factor from the gestational age at birth?]

Objective: Compare, at the same gestational age at birth, survival without severe neonatal morbidity among live-born infants after previable premature rupture of membranes (PROM) occurring before 22 weeks of gestation (WG) versus at or after 22 weeks.

Methods: Retrospective study conducted in a tertiary care referral center between 2016 and 2021, including live births between 23 and 36 weeks + 6 days after PROM. Only live-born infants with neonatal resuscitation care were included. Each infant from the group PROM < 22 weeks was matched for gestational age at birth with the next two infants born after PROM ≥ 22 weeks. Maternal characteristics, obstetric outcomes, and neonatal outcomes were compared between the two groups. The primary outcome was survival without severe neonatal morbidity at discharge Results: In total, 35 infants were included in the PROM < 22weeks group and 70 in the PROM ≥22 weeks group. The median gestational age at birth was 28.4 weeks (IQR [25,3-31,2]). The rate of survival without severe neonatal morbidity was significantly lower in the PROM <22 weeks group compared to the PROM ≥22 weeks group (15/35 (42.9 %) vs 58/70 (82.9 %), p<0,01)). The number of deaths in the neonatal intensive care unit before 36 weeks corrected age was higher in the PROM <22 weeks group (6 (17.1%) versus 3 (4.3%), p=0.03)).

Conclusion: Previable PROM is associated with a survival rate without severe neonatal morbidity that is twice lower than infants born at the same gestational age after PROM ≥ 22 weeks.