From prolonged premature rupture of membranes to bronchopulmonary dysplasia: the role of chorioamnionitis in the respiratory outcomes of preterm infants

Abstract

Introduction. Prolonged premature rupture of membranes predisposes to intrauterine infection and chorioamnionitis, both of which have significant implications for neonatal outcomes. While chorioamnionitis has been linked to accelerated surfactant production and reduced respiratory distress syndrome, it is also associated with long-term pulmonary injury, including bronchopulmonary dysplasia and pulmonary hypertension. The objective of the study is to investigate the association between prolonged premature rupture of membranes, chorioamnionitis, and respiratory outcomes among preterm infants ≤34 weeks of gestation. Material and methods. A prospective cohort of 108 preterm infants admitted to the Neonatal Intensive Care Unit of the Mother and Child Institute, Chișinău, between October 2023 and July 2024, was divided into two groups: infants born to mothers with clinical/histological chorioamnionitis (n = 54) and controls (n = 54). Maternal risk factors, incidence of prolonged premature rupture of membranes incidence, Apgar scores, type and duration of respiratory support, and pulmonary complications were analyzed. Statistical significance was tested using chi-square and logistic regression. Results. Prolonged premature rupture of membranes was significantly more frequent in chorioamnionitis group (67% vs. 22%, p<0.001). Infants exposed to chorioamnionitis had lower 1-minute Apgar scores, greater need for invasive ventilation (5.9 ± 10.6 vs. 2.2 ± 4.8 days, p<0.05), and prolonged hospitalization. BPD incidence was higher in the chorioamnionitis group (25.9% vs. 3.7%, p<0.05). Mortality did not differ significantly between groups (27.8% vs. 22.2%). Conclusions. Prolonged premature rupture of membranes is strongly associated with chorioamnionitis, which in turn significantly increases the risk of long-term pulmonary complications in preterm infants. Early recognition of prolonged premature rupture of membranes, antibiotic prophylaxis, antenatal corticosteroids, and interdisciplinary obstetric–neonatal management are essential to reduce the burden of bronchopulmonary dysplasia.