Child outcomes after amnioinfusion compared with no intervention in women with second‐trimester rupture of membranes: a long‐term follow‐up study of the PROMEXIL‐III trial

Objective To assess the effect of transabdominal amnioinfusion or no intervention on long‐term outcomes in children born after second‐trimester prelabour rupture of the membranes (PROM between 16+0/7–24+0/7 weeks) and oligohydramnios. Population Follow up of infants of women who participated in the...

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Published in:	BJOG : an international journal of obstetrics and gynaecology Vol. 128; no. 2; pp. 292 - 301
Main Authors:	Ruigh, AA, Simons, NE, Hooft, J, Teeffelen, AS, Duijnhoven, RG, Wassenaer‐Leemhuis, AG, Aarnoudse‐Moens, C, Beek, C, Oepkes, D, Haak, MC, Woiski, M, Porath, MM, Derks, JB, Kempen, LEM, Roseboom, TJ, Mol, BW, Pajkrt, E
Format:	Journal Article
Language:	English
Published:	England Wiley Subscription Services, Inc 01-01-2021 John Wiley and Sons Inc
Subjects:	Adult Age Factors Amniotic Fluid Child development Child, Preschool Children Clinical outcomes Clinical trials Developmental disabilities Female Fetal Membranes, Premature Rupture - therapy Follow up Follow-Up Studies Humans infant development Infants Infusions, Parenteral Intelligence Male Medical treatment neurodevelopment Neurodevelopmental Disorders - epidemiology oligohydramnios Original Pregnancy Pregnancy complications Pregnancy Trimester, Second Respiratory Tract Diseases - epidemiology Saline Solution - administration & dosage second‐trimester prelabour rupture of the membranes Survival Womens health Young Adult Follow up neurodevelopment oligohydramnios second-trimester prelabour rupture of the membranes infant development
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Summary:	Objective To assess the effect of transabdominal amnioinfusion or no intervention on long‐term outcomes in children born after second‐trimester prelabour rupture of the membranes (PROM between 16+0/7–24+0/7 weeks) and oligohydramnios. Population Follow up of infants of women who participated in the randomised controlled trial: PPROMEXIL‐III (NTR3492). Methods Surviving infants were invited for neurodevelopmental assessment up to 5 years of corrected age using a Bayley Scales of Infant and Toddler Development or a Wechsler Preschool and Primary Scale of Intelligence. Parents were asked to complete several questionnaires. Main outcome measures Neurodevelopmental outcomes were measured. Mild delay was defined as −1 standard deviation (SD), severe delay as −2 SD. Healthy long‐term survival was defined as survival without neurodevelopmental delay or respiratory problems. Results In the amnioinfusion group, 18/28 children (64%) died versus 21/28 (75%) in the no intervention group (relative risk 0.86; 95% confidence interval [CI] 0.60–1.22). Follow‐up data were obtained from 14/17 (82%) children (10 amnioinfusion, 4 no intervention). In both groups, 2/28 (7.1%) had a mild neurodevelopmental delay. No severe delay was seen. Healthy long‐term survival occurred in 5/28 children (17.9%) after amnioinfusion versus 2/28 (7.1%) after no intervention (odds ratio 2.50; 95% CI 0.53–11.83). When analysing data for all assessed survivors, 10/14 (71.4%) survived without mild neurodevelopmental delay and 7/14 (50%) were classified healthy long‐term survivor. Conclusions In this small sample of women suffering second‐trimester PROM and oligohydramnios, amnioinfusion did not improve long‐term outcomes. Overall, 71% of survivors had no neurodevelopmental delay. Tweetable Healthy long‐term survival was comparable for children born after second‐trimester PROM and treatment with amnioinfusion or no intervention. Tweetable Healthy long‐term survival was comparable for children born after second‐trimester PROM and treatment with amnioinfusion or no intervention.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-News-3 content type line 23 Presentation: Presented as a poster at the 38th Annual Meeting of the Society of Maternal Fetal Medicine, 11–16 February 2019, Las Vegas, Nevada, USA Linked article This article is commented on by DW Skupski, p. 302 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16187. Each author has confirmed compliance with the journal’s requirements for authorship.
ISSN:	1470-0328 1471-0528
DOI:	10.1111/1471-0528.16115