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Am J Perinatol
DOI: 10.1055/a-2698-0900
Original Article

Long-Term Neurodevelopmental Outcomes at 5 Years in Preterm Infants Born At <27 Weeks' Gestational Age following Preterm Premature Rupture of Membranes

Authors

  • Sarah Tougas

    1   Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    2   Neonatal Follow-up Clinic, Alberta Health Services, Calgary, Alberta, Canada

  • Harkirat Bhullar

    1   Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    2   Neonatal Follow-up Clinic, Alberta Health Services, Calgary, Alberta, Canada

  • Amelie Stritzke 

    1   Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    2   Neonatal Follow-up Clinic, Alberta Health Services, Calgary, Alberta, Canada

  • Selphee Tang

    2   Neonatal Follow-up Clinic, Alberta Health Services, Calgary, Alberta, Canada

  • Sue Makarchuk

    2   Neonatal Follow-up Clinic, Alberta Health Services, Calgary, Alberta, Canada

  • Abhay Lodha 

    1   Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    2   Neonatal Follow-up Clinic, Alberta Health Services, Calgary, Alberta, Canada
    3   Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    4   Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Abstract

Objective

This study aimed to determine the association between preterm premature rupture of membranes (PPROM) and neurodevelopmental outcomes at 5 years of age in infants born before 27 weeks of gestation.

Study Design

Infants born before 27 weeks of gestational age (GA) between 2005 to 2014 and 2017 to 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 neurodevelopmental impairment (NDI) at 5 years of age. NDI was considered present if a child had any of cerebral palsy, full-scale intelligence quotient >1 standard deviation 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. A total of 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. After adjusting for confounders, the odds ratio of death or NDI in the PPROM group were 1.14 (95% confidence interval: 0.82–1.58). The study also provided comprehensive evaluations of the primary and secondary outcomes through propensity score–matched analyses.

Conclusion

Our study suggests that PPROM may not be associated with an increased risk of a composite outcome of death or NDI at 5 years of age in preterm infants born before 27 weeks of GA.

Key Points

  • We compared infants born < 27 weeks GA with and without PPROM.

  • Infants were assessed at 5 years of age for NDI.

  • There was no difference in death or NDI between groups.

Keywords

preterm - premature rupture of membranes - neurodevelopmental impairment


Publication History

Received: 04 June 2025

Accepted: 08 September 2025

Article published online:
22 September 2025

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