(170) Decreased Rates of NICU Admissions and Neonatal Transfers after Delayed Delivery for PPROM in NY

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: In March 2020, guidelines were changed allowing expectant management up to 37w for preterm prelabor rupture of membranes (PPROM). This change may impact referral patterns and there is evidence that neonatal outcomes are less optimal when transfer is necessary after delivery. The objective of this study was to assess if this practice change has impacted outcomes and transfers to higher levels of care.

Study Design: This is a retrospective cohort analysis of singleton, pregnant individuals at 16 hospitals in New York State delivered between 34-36+6w with PPROM from 1/2015-6/2022. Data was obtained from the NYS birth certificate database. Pregnancies with multiple gestations, stillbirths, and known fetal malformations were excluded. Primary outcomes included gestational age of delivery, antenatal corticosteroid administration, and proportion of neonatal transfers before and after March 2020.

Results: A total of 879 pregnant individuals delivered before March 2020 (69.4%) and 386 delivered after (30.5%). At the referral hospital, the percentage of PPROM deliveries did not change over time (p=0.06, Figure 1) but there were fewer neonatal transfers after March 2020 (before: 5.2% vs after: 2.3%, p=0.03, Table 1). There was no difference in gestational age of delivery in all hospitals (Table 1). At the referral hospital, deliveries after March 2020 occurred at a later gestational age (before: 34.8±0.1 vs. after: 35.0±0.1 weeks, p=0.02) and there were fewer NICU admissions (before: 61.3% vs after: 48.9%, p=0.02, Table 1). Significantly more patients received antenatal corticosteroids after March 2020 at all hospitals (47.2% vs 26.1%, p< 0.01).

Conclusion: Since the change in practice guidelines for PPROM management in March 2020, there has been a decrease in neonatal transfers and a decrease in the number of NICU admissions at the referral hospital. This observed association likely reflects the benefit of expectant management and late preterm steroids in this population. Future research should focus on predictors for NICU admission to further refine protocols for transfer to higher levels of care.

Primary & Presenting Author(s)

Derek Lee, MD
Fellow Physician
Albany Medical Center
Albany, New York, United States

Coauthor(s)

JG
Jamie Gifford, BS
Regional Data Coordinator
Albany Medical Center
Albany, New York, United States
TL
Tara A. Lynch, MD
Albany Medical Center
Albany, New York, United States