Respiratory Distress Syndrome in Infants Delivered via Cesarean from Mothers with Preterm Premature Rupture of Membranes: A Propensity Score Analysis

Objective. This study aimed to clarify the effects of cesarean delivery on neonatal respiratory morbidity when women had preterm premature rupture of membranes. Methods. This retrospective study included women with preterm premature rupture of membranes who delivered from 23 weeks to 33 weeks of gestation between January 2009 and December 2014. Neonatal outcomes were compared between infants delivered by cesarean section and those delivered vaginally. The primary outcome was respiratory distress syndrome (RDS). Neonatal intubation and mechanical ventilation periods were secondary outcomes. Propensity score matching was used to compare outcomes between cesarean and vaginal delivery cases. Results. There were 101 cesarean deliveries and 89 vaginal deliveries. A comparison of the presence or absence of neonatal complications based on the delivery type indicated a higher occurrence of RDS with cesarean deliveries (P=0.025). The intubation and mechanical ventilation periods were not significantly longer in neonates delivered via cesarean section. Conclusions. Cesarean delivery is a risk factor for neonatal RDS in women with preterm premature rupture of membranes. Trials identifying long-term neonatal prognoses are needed to further develop optimal management strategies in such cases.

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Evaluation of the impact of residual anhydramnios following preterm premature rupture of membranes on respiratory distress syndrome

Perinatal Journal ◽

10.2399/prn.21.0291003 ◽

2021 ◽

Vol 29 (1) ◽

pp. 13-19

Author(s):

Erdem Şahin ◽

Yusuf Madendağ

Keyword(s):

Birth Weight ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Cesarean Delivery ◽

Distress Syndrome ◽

Latency Period ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

The Impact

Objective The aim of the present study was to evaluate the impact of residual anhydramnios following preterm premature rupture of membranes (PPROM) on respiratory distress syndrome (RDS) after the pregnancy was expectantly managed. Methods This study was retrospectively conducted at Erciyes University Medical School, Turkey. It assessed women with singleton pregnancies admitted to the hospital between 2010 and 2020 for expectant management of PPROM between 24th and 28th gestational weeks. The patients were divided into three groups as follows: (1) anhydramnios, (2) oligohydramnios, (3) normal amniotic fluid volume (AFV). Main outcome measure was as follows: The first evaluation was AFV at admission and the primary outcome was a neonatal RDS. Adjusted odds ratios (aOR) and 95% confidence interval (CI) for RDS were calculated for each AFV-at-presentation adjusting for gestational age (GA) at PPROM, GA at delivery, latency period, birth-weight percentile, cesarean birth, and chorioamnionitis. Results Of the 440 women with PPROM, 261 fulfilled the inclusion criteria. There were 125 (47.8%) with normal AFV, 71 (27.3%) with oligohydramnios, and 65 (24.9%) with anhydramnios at admission. The maternal demographic characteristics were similar among the groups. Birth weight was significantly different among the groups. RDS was highest in the anhydramnios group (64.6%). Decreased AFV was not associated with RDS in either oligohydramnios or anhydramnios at presentation. A GA at PPROM, latency period >30 days, and cesarean delivery were co-factors in the outcome. Conclusion Our results indicated that oligohydramnios and anhydramnios were not associated with RDS risk, but GA at PPROM and delivery, latency period, and cesarean delivery were independently associated with the RDS risk.

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Latency duration of preterm premature rupture of membranes and neonatal outcome: a retrospective single-center experience

European Journal of Pediatrics ◽

10.1007/s00431-021-04245-2 ◽

2021 ◽

Author(s):

Hanna Müller ◽

Ann-Christin Stähling ◽

Nora Bruns ◽

Christel Weiss ◽

Maria Ai ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Bronchopulmonary Dysplasia ◽

Gestational Age ◽

Distress Syndrome ◽

Neonatal Outcome ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Preterm Premature Rupture ◽

Latency Duration

AbstractIn preterm premature rupture of membranes (PPROM), a decision between early delivery with prematurity complications and pregnancy prolongation bearing the risk of chorioamnionitis has to be made. To define disadvantages of delayed prolongation, latency duration of PPROM in expectantly managed pregnancies was investigated. We included those PPROMs > 48 h leading to preterm birth prior 37 weeks’ gestation and retrospectively analyzed 84 preterm infants fulfilling these criteria. The association between latency duration/appearance of PPROM and respiratory outcome (primary outcomes) and neurological outcome (secondary outcomes) was investigated. The study showed that latency duration of PPROM is not associated with clinical or histological chorioamnionitis (p = 0.275; p = 0.332). As the numerous clinical parameters show multicollinearity between each other, we performed a multiple regression analysis to consider this fact. Respiratory distress syndrome is significantly associated with gestational age at PPROM (p < 0.001), and surfactant application is significantly associated with PPROM duration (p = 0.014). The other respiratory parameters including steroids and diuretics therapy, bronchopulmonary dysplasia, and the neurological parameters (intraventricular hemorrhage, Bayley II testing at a corrected age of 24 months) were not significantly associated with PPROM duration or gestational age at PPROM diagnosis.Conclusion: Latency duration of PPROM was not associated with adverse neonatal outcome in expectantly and carefully managed pregnancies, but respiratory distress syndrome was pronounced. The observed effect of pronounced respiratory distress syndrome can be treated with surfactant preparations and was not followed by increased rate of bronchopulmonary dysplasia. What is Known:• In case of preterm premature rupture of membranes, a decision between pregnancy prolongation with the risk of chorioamnionitis and early delivery with prematurity complications has to be made.• Chorioamnionitis is a dangerous situation for the pregnant woman and the fetus.• Impaired neurodevelopmental outcome is strongly correlated with pronounced prematurity due to the increased rate of serious complications. What is New:• Respiratory distress syndrome is significantly associated with gestational age at PPROM, and surfactant application is significantly associated with PPROM duration.• Latency duration of PPROM is not associated with adverse respiratory neonatal outcome (therapy with continuous positive airway pressure, therapy with diuretics and/or steroids, bronchopulmonary dysplasia) in expectantly and carefully managed pregnancies.• Intraventricular hemorrhage and Bayley II testing at a corrected age of 24 months are not associated with latency duration of PPROM when pregnancies are carefully observed.

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A Randomised Controlled Trial of 12 Hours vs 24 Hours Betamethasone Dosing Interval in Preterm Premature Rupture of Membranes for Prevention of Respiratory Distress Syndrome (RDS) in Neonates

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v7i8.112 ◽

2019 ◽

Vol 7 (8) ◽

Author(s):

Dr Sandeep Sharma ◽

Keyword(s):

Randomised Controlled Trial ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Controlled Trial ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Dosing Interval ◽

Preterm Premature Rupture ◽

Randomised Controlled

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Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

Frontiers in Pharmacology ◽

10.3389/fphar.2021.614465 ◽

2021 ◽

Vol 12 ◽

Author(s):

An-Min Hu ◽

Xiong-Xiong Zhong ◽

Zhen Li ◽

Zhong-Jun Zhang ◽

Hui-Ping Li

Keyword(s):

At Risk ◽

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Propensity Score ◽

Hospital Mortality ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Research Database ◽

Matched Cohort

Background: Sedatives are commonly used in patients with or at risk for acute respiratory distress syndrome (ARDS) during mechanical ventilation. To systematically compare the outcomes of sedation with midazolam, propofol, and dexmedetomidine in patients with or at risk for ARDS.Methods: We developed a dataset of real-world data to enable the comparison of the effectiveness and safety of sedatives and the associated outcomes from the MIMIC-III database and the eICU Collaborative Research database. We performed a systematic study with six cohorts to estimate the relative risks of outcomes among patients administered different sedatives. Propensity score matching was performed to generate a balanced 1:1 matched cohort and to identify potential prognostic factors. The outcomes included hospital mortality, duration of mechanical ventilation, length of intensive care unit stay, length of hospitalization, and likelihood of being discharged home.Results: We performed 60 calibrated analyses among all groups and outcomes with 17,410 eligible patients. Sedation with dexmedetomidine was associated with a lower in-hospital mortality rate than sedation with midazolam and propofol or sedation without dexmedetomidine (p < 0.001). When compared with no sedation, the use of midazolam, propofol or dexmedetomidine was associated with a longer ICU stay and longer hospitalization duration (p < 0.01). Patients treated with midazolam were relatively less likely to be discharged home (p < 0.05).Conclusion: Patients treated with dexmedetomidine had a reduced risk of mortality. These data suggest that dexmedetomidine may be the preferred sedative in patients with or at risk for ARDS.

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