Incidence and Risk Factors of Neonatal Sepsis in Preterm Premature Rupture of Membranes before 34 Weeks of Gestation

Abstract

Objective: Early-onset neonatal sepsis (EONS) is a leading cause of newborn morbidity and mortality, particularly in preterm premature rupture of membranes (PPROM) before 34 weeks of gestation, in which expectant management was performed until reaching 34 weeks of gestation, evidence of maternal chorioamnionitis, or unfavorable fetal conditions. The interval between membrane rupture and delivery has a positive correlation with neonatal sepsis. The purpose of this study was to investigate the incidence and risk factors of EONS in PPROM.Materials and Methods: This was a retrospective cross-sectional study. The medical records of pregnant women who gave birth between 2005 and 2018 and their newborns were reviewed. The inclusion criterion was singleton pregnancies complicated by PPROM between 24 and 33+6 weeks of gestation. Multifetal pregnancies, fetal malformation, stillbirths, and records with incomplete data were excluded. PPROM was diagnosed by obstetricians while EONS was diagnosed by neonatologist.Results: The incidence of EONS in with PPROM was 24%. Risk factors included excessive maternal weight gain based on IOM (OR = 2.40, 95% CI = 1.16-4.94), extremely preterm at admission (before 28 weeks of gestation) (OR = 3.38, 95% CI 1.12-10.21) and very low birth weight (≤ 1,500 g) (OR 3.68, 95% CI = 1.86-7.30). Maternal hematologic laboratory results were not associated with neonatal sepsis.Conclusion: The incidence of EONS in PPROM was similar to data provided by other studies. Obstetricians and pediatricians should be cautious about neonatal sepsis, especially in cases of excessive maternal weight gain, extremely preterm admissions, and very low birth weight.

Accounts of adverse neonatal effects in preterm prelabor rupture of membranes: anticipating maternal platelet indices and C-reactive protein as effective biomarkers

“…Previous studies have reported the rate of RDS in <37 weeks of gestation to be between 30-50% [Nagendra K et al, 1999;Dun-The New Armenian Medical Journal, Vol. 17 (2023), 1, p. Sai Bhavana D. et al 84-93 dar B et al, 2018 and the rate of early-onset neonatal sepsis to be varying between 10-35% [Jaiswal A et al, 2017;Dundar B et al, 2018;Sirivunnabood T et al, 2022]. Assuming the rate of RDS to be around 40% and the rate of early-onset neonatal sepsis of 25% in PPROM (local data), with 5% α error and 95% confidence interval, the sample size achieved was a minimum of 72.…”