100 Long-term neurodevelopmental outcomes at 5 years in preterm infants born at <27 weeks gestational age following Preterm Premature Rupture of Membranes (PPROM)

Background Approximately one-third of preterm births are complicated by preterm premature rupture of membranes and result in significant neonatal morbidity and mortality. However, it is unclear how it affects long-term neurodevelopmental outcomes at five years of age. Objectives To determine the association between preterm premature rupture of membranes (PPROM) and neurodevelopmental impairment (NDI) at 5 years of age in infants born before 27 weeks of gestation. Design/Methods Infants born before 27 weeks GA between 2005-2014 and 2017-2018 and evaluated at the neonatal follow-up clinic at age 5 years were included. Outcomes were assessed based on abnormal muscle tone, hearing and vision assessments, and cognitive assessment on standardized testing. Perinatal/neonatal characteristics and outcomes were compared between the PPROM (ruptured membranes >1 hour prior to onset of contractions) and No PPROM groups using univariate tests and multivariable regression models. The primary outcome was a composite of death or NDI at 5 years of age. NDI was considered present if a child had any of cerebral palsy, full scale intelligence quotient >1 SD below the mean, sensorineural hearing loss, or corrected visual acuity <20/60 in the better eye. Results A total of 566 eligible infants were followed up in our regional follow-up clinic at 5 years of age. 226 (40%) were in the PPROM group and 340 (60%) were in the No PPROM group. Infants in the PPROM and No PPROM groups had mean birth weights of 758 (±141) and 740 (±159) grams, respectively, and a median GA of 25 (range 22-26) weeks for both groups (Table 1). After adjusting for confounders, the odds ratio of death or NDI in the PPROM group were 1.14 (95% CI, 0.82 to 1.58) (Table 2). Detailed primary and secondary outcomes with propensity scores matched analyses are shown in the Table 2. Conclusion Our study suggests that PPROM is not associated with an increased risk of a composite outcome of death or neurodevelopmental impairment (NDI) at 5 years of age in preterm infants born before 27 weeks of gestational age.