Objective: To evaluate the relationship between maternal leukocytosis in women admitted after preterm premature rupture of the membranes (PPROM) and the neurodevelopmental outcomes of their infants at two years of age.
Methods: A prospective cohort study of women with PPROM occurring between 24 weeks and 33 weeks and 6 days of gestation was conducted in a region of France over two years. The primary outcome was a composite of neurodevelopmental variables, including motor impairment (an inability to stand without support, walk, run, or climb or descend stairs alone), auditory impairment, visual impairment, or the presence of monoplegia, diplegia, or hemiplegia at two years of age. Multiple logistic regression analysis was used to adjust for confounding factors.
Results: Of 394 cases, 6/64 neonates (9.4%) born to mothers with leukocytosis were no longer alive at the two-year follow-up, compared with 14/330 (4.2%) born to mothers with no leukocytosis (P = 0.09). At two years of age, 28 (56%), 22 (52%), 34 (49%), and 52 infants (37%) showed at least one of the primary outcome features for PPROM occurring at 24-27, 28-29, 30-31, and 32-33 weeks' gestation, respectively. In univariate analysis, PPROM at less than 30 weeks, leukocytosis, and cerclage were associated with a higher rate of the primary outcome. In logistic regression analysis, only leukocytosis remained significant (odds ratio [OR] 2.92; 95% confidence intervals [CI] 1.33-6.39, P = 0.02). Fewer infants whose mothers had a leukocyte count (WBC) .15 000/mm3 at the time of PPROM showed a feature of the primary outcome at two years of age than infants whose mothers had a higher WBC (P < 0.01).
Conclusion: Maternal leukocytosis at admission is associated with higher adverse infant neurodevelopmental outcomes at two years of age. Guidelines for the management of women with PPROM who do not begin to labour should include consideration of the degree of leukocytosis.