Outcomes of Neonates Born to Mothers with Premature Rupture of the Membrane: A Systematic Review and Meta-analysis

Abstract

Premature rupture of membranes (PROM) occurs when the amniotic sac membranes rupture before labor begins. Identifying and managing PROM risk factors early can reduce neonatal sepsis and mortality, ensuring the health of both mothers and newborns. This meta-analysis (PROSPERO ID:CRD42021282387) evaluated the association of neonatal sepsis, morbidity, and mortality with PROM lasting less than 24 h. Sixteen studies were selected for meta-analysis after a systematic review with predefined inclusion and exclusion criteria from databases including MEDLINE (via PubMed), Scopus and ScienceDirect. Both cohort and case-control studies were included, and their quality was assessed separately using the Newcastle-Ottawa Scale. A fixed-effect model was applied when I² < 50%; otherwise, a random-effects model was used. Publication bias was assessed using a funnel plot and Egger’s test. STATA version 16 was used to perform the meta-analysis. The overall pooled relative risk for sepsis, morbidity, and mortality associated with PROM < 24 h were found to be 0.44 [95% CI: 0.22, 0.88], 0.63 [95% CI: 0.50, 0.79], and 0.37 [95% CI: 0.28, 0.50], respectively, indicating that neonates born to mothers with PROM < 24 h have a lower risk of sepsis, morbidity, and mortality compared to those born to mothers with PROM ≥ 24 h. However, the search was limited to studies published up to June 2020, and newer evidence may affect these findings.