Document Detail


Neonatal mortality and morbidity after aggressive long-term tocolysis for preterm premature rupture of the membranes.
MedLine Citation:
PMID:  16757913     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To test the hypothesis that predischarge morbidity and mortality are not increased for infants admitted to our neonatal intensive care unit and whose mothers had tocolysis for >48 h plus antibiotics and steroids (aggressive long-term tocolysis) after preterm premature rupture of the membranes (PPROM) as compared with gestational age-matched infants born to mothers not treated for PPROM. METHODS: A retrospective cohort study was conducted on live preterm births (<or=36.0 weeks) admitted to the neonatal intensive care unit between January 1, 1999 and June 30, 2003, comparing singletons born to mothers with PPROM+tocolysis for >48 h (n=137, group 1) with singletons born to all other mothers matched for group-1 gestational age at delivery (n=628, group 2), excluding severe maternal complications such as insulin-dependent diabetes and preeclampsia in both groups. Primary outcome was the predischarge mortality and morbidity of the neonates. RESULTS: In the group with post-PPROM tocolysis which lasted for 14.4+/-14.0 days with a latency of 15.3+/-15.3 days (time from PPROM to delivery) and 14.4+/-14.0 days (time from the start of tocolysis to delivery), the predischarge mortality and morbidity was not increased compared to the non-treated group. The 1- and 10-min Apgar scores of between 1 and 7 were less frequent with tocolysis (p<0.05), and oxygen use was less frequent (26.3 vs. 36.3%, p=0.03) and shorter (8.7 vs. 19.6 days, p=0.03). However, amniotic fluid infection syndrome and latency (i.e. >1 week) are the most potential predictors of the respiratory distress syndrome in addition to gestational age at delivery in pregnancies with post-PPROM tocolysis. CONCLUSIONS: Amniotic fluid infection syndrome and a latency of >1 week achieved by aggressive post-PPROM tocolysis lessens the advantages of extended gestational age and decreased predischarge neonatal morbidity. These findings may have important implications for the clinical management of PPROM.
Authors:
Aline Wolfensberger; Roland Zimmermann; Ursula von Mandach
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Fetal diagnosis and therapy     Volume:  21     ISSN:  1015-3837     ISO Abbreviation:  Fetal. Diagn. Ther.     Publication Date:  2006  
Date Detail:
Created Date:  2006-06-07     Completed Date:  2006-10-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9107463     Medline TA:  Fetal Diagn Ther     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  366-73     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2006 S. Karger AG, Basel.
Affiliation:
Department of Obstetrics, Zurich University Hospital, Zurich, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Female
Fetal Membranes, Premature Rupture / therapy*
Gestational Age
Humans
Infant Mortality*
Infant, Newborn
Logistic Models
Morbidity
Pregnancy
Retrospective Studies
Time Factors
Tocolysis / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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