Fetal Urine Production Rate in Preterm Premature Rupture of Membranes Is Associated with Adverse Neonatal Outcome: A Pilot Study

Introduction In this study we evaluated the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). Material and Methods We conducted a prospective cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later in a single center. Women with PPROM and conservative management until spontaneous labor (after 48 hours of admission), chorioamnionitis, or induction by protocol at 35+0 weeks. FUPR was evaluated by 2D sonography at admission, and corrected for gestational age. Attending physicians were blinded to FUPR results. The main neonatal outcome measures were chorioamnionitis, placental inflammatory grading, first neonatal creatinine value, first neonatal dextrose value, length of neonatal intensive care unit (NICU) stay, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grades I-IV), blood transfusions, reduced neonatal urine production rate ( Results The study included 38 women. Low FUPR was associated with chorioamnionitis, longer NICU hospitalization (p=0.01), and higher rates of NEC or IVH (p=0.008), and blood transfusion (p=0.004). There were no significant associations between antenatal FUPR and placental histologic inflammation grading, neonatal creatinine, neonatal dextrose, or early neonatal sepsis. IL-6 levels did not correlate with chorioamnionitis, FUPR, or early sepsis. Conclusion A finding of FUPR on in utero ultrasound examination in pregnancies complicated by PPROM may be indicative of an inflammatory process and predictive of adverse neonatal outcome.</p