Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To determine timing of birth and neonatal outcomes after previable preterm premature rupture of the membranes (PPROM) <22 weeks versus no prolonged PPROM, to aid perinatal counselling at viability. METHODS: We conducted a retrospective cohort study of 8071 liveborn singletons born <32 weeks between 2018-2022, who received active care and died in the resuscitation room or were admitted to a neonatal intensive care unit in Canada. Associations between previable PPROM and birth timing (and latency period) were investigated. Outcomes were compared between previable PPROM and no prolonged PPROM. Our primary outcome was a composite of mortality or severe neonatal morbidity (respiratory distress syndrome, severe neurological injury, severe necrotizing enterocolitis, severe retinopathy of prematurity, bronchopulmonary dysplasia, or sepsis). Multivariable generalized estimating equations accounted for the hospital effect. RESULTS: 225 infants experienced PPROM <22 weeks (65% born extremely preterm) and 7846 had rupture of membranes <24 hours at 22-31 weeks (36% born extremely preterm). As PPROM timing increased (≤16 to 21 weeks), median gestational age at birth decreased [27.5 weeks (IQR 24.5, 29.0) to 25.0 (IQR 23.0, 28.0)]. Previable PPROM infants had increased odds of mortality/severe neonatal morbidity (90%) versus those without prolonged PPROM (66%, adjusted OR 1.71, 95% CI 1.14 to 2.56), but 77% survived to discharge. CONCLUSION: In our large cohort of previable PPROM reaching viability, gestational age at rupture and birth were inversely related. Most previable PPROM infants who reached viability and received active care were born extremely preterm, nearly all experienced severe morbidity, but three quarters survived.
Authors: Anja Gojic, Yanchen Wang, Prakesh S. Shah, Seungwoo Lee, Eleanor Pullenayegum, Amit Mukerji, Eugene Ng, Miroslav Stavel, Swati Agrawal, Sarah D. McDonald, Marc Beltempo, Prakesh S. Shah, Thevanisha Pillay, Jonathan Wong, Miroslav Stavel, Rebecca Sherlock, Ayman Abou Mehrem, Jennifer Toye, Joseph Ting, Carlos Fajardo, Andrei Harabor, Lannae Strueby, Mary Seshia, Deepak Louis, Chelsea Ruth, Ann Yi, Amit Mukerji, Orlando Da Silva, Sajit Augustine, Kyong-Soon Lee, Eugene Ng, Brigitte Lemyre, Brigitte Lemyre, Faiza Khurshid, Victoria Bizgu, Nina Nouraeyan, Keith Barrington, Anie Lapointe, Guillaume Ethier, Christine Drolet, Martine Claveau, Marie St-Hilaire, Valerie Bertelle, Edith Masse, Paloma Costa, Hala Makary, Ahmad Aziz, Gabriela de Carvalho Nunes, Wissam Alburaki, Jo-Anna Hudson, Jehier Afifi, Andrzej Kajetanowicz, Bruno Piedboeuf, Wendy Whittle, Swati Agarwal, Kenneth Lim, Jessica Liauw, Darine El-Chaar, Katherine Theriault, Marie-Ève Roy-Lacroix, Kimberly Butt, Candace O’Quinn, Christy Pylypjuk, Isabelle Boucoiran, Catherine Taillefer, Joan Crane, Haim Abenhaim, Graeme Smith, Karen Wou, Sue Chandra, Jagdeep Ubhi, Ernesto Figueiro-Filho, Michael Helewa, Ariadna Grigoriu, Rob Gratton, Cynthia Chan, Gabriela de Caralho Nunes, Ludmila Porto, Nir Melamed, Jason Burrows, Sajit Augustine, Lara Wesson, Erin MacLellan, James Hayward, Victoria Allen
Institutions: McMaster University, Mount Sinai Hospital, University of Toronto, Hospital for Sick Children, Sunnybrook Health Science Centre, Royal Columbian Hospital, Surrey Memorial Hospital, Victoria General Hospital, Alberta Hospital Edmonton, University of Alberta Hospital, Regina General Hospital, Foothills Medical Centre, Alberta Children's Hospital, Health Sciences Centre, Hamilton Health Sciences, London Health Sciences Centre, Ottawa Hospital, Children's Hospital of Eastern Ontario, Jewish General Hospital, Centre hospitalier universitaire de Québec, Kingston General Hospital, Montreal Children's Hospital, McGill University Health Centre, Saint John Regional Hospital, Hôpital Maisonneuve-Rosemont, Centre Hospitalier Universitaire de Sherbrooke, Izaak Walton Killam Health Centre, Cape Breton Regional Hospital, Centre Hospitalier Universitaire Sainte-Justine, Dr. Everett Chalmers Regional Hospital, Janeway Children's Health and Rehabilitation Centre, Royal Alexandra Hospital, Stollery Children's Hospital, Windsor Regional Hospital
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,100
OpenAlex ID: W7166530847