PROLONGED RUPTURE OF MEMBRANES (PROM): IMPLEMENTATION OF PRACTICE GUIDELINE ALLOWING OBSERVATION WITHOUT ANTIBIOTIC THERAPY FOR LOW RISK INFANTS 1795 Academic Article uri icon

abstract

  • Recommendations for management of infants born after PROM vary between universal and selective antibiotic therapy. Little outcome data is available. Prior to 1989, all infants born at our institution with PROM were treated with antibiotics. In 1989, we implemented an algorithmic practice guideline that defined low risk infants as those who were asymptomatic, born to asymptomatic mothers and had a normal blood count. These infants were observed without antibiotic therapy unless signs of sepsis developed or the blood culture subsequently grew a pathogen. High risk infants (mothers with suspected chorioamnionitis: signs of suspected sepsis shortly after birth) were treated with antibiotics for at least 3 days until culture results were available. Between 1986 and 1991, data were collected prospectively on all infants who developed sepsis and/or meningitis. During the 6 year study period, 52.912 infants were born, of whom 1376 (2.6%) had PROM of greater than 24 hours. 20 infants (1.5%) developed early sepsis (<7 days). One infant had both sepsis and meningitis and no infants had meningitis without sepsis. Nineteen of the twenty infants were born at less than 37 weeks. Only one infant was born at term and he was symptomatic shortly after birth and received antibiotic therapy. 7/20 infants died: 4 of pulmonary hypoplasia and 3 of causes related to prematurity. No infant died of sepsis. Ten infants had sepsis during the period of universal antibiotics and ten during the period with the above practice guideline.

publication date

  • January 1, 1996