Respiratory Distress Syndrome (RDS) is the Most Common Neonatal Complication
For a neonate born at 35 weeks following PPROM at 31 weeks, respiratory distress syndrome (RDS) is the most common complication, with incidences up to 50% among surviving neonates after PPROM. 1
Evidence-Based Rationale
The 2024 Society for Maternal-Fetal Medicine guidelines explicitly state that respiratory distress and bronchopulmonary dysplasia are common among surviving neonates after PPROM, with incidences reaching up to 50%. 1 This is significantly higher than the other complications listed in your question.
Comparative Incidence of Complications
Respiratory complications dominate the clinical picture:
- Respiratory distress syndrome and bronchopulmonary dysplasia: up to 50% 1
- Neonatal sepsis: 5-25% 1
- Skeletal deformities: 5-25% 1
- Other complications (intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity): 5-25% 1
Pathophysiologic Mechanism
The prolonged oligohydramnios from PPROM at 31 weeks directly impacts fetal lung development during the critical canalicular and saccular stages (16-36 weeks). 1 Lack of sufficient amniotic fluid volume during this period results in:
- Pulmonary hypoplasia (a major contributor to neonatal mortality) 1
- Impaired surfactant production
- Reduced alveolar development 1
This respiratory compromise persists long-term: 50% of children at age 2 years and 57% at age 5 years continue to require respiratory medications. 1
Clinical Context for 35-Week Delivery
At 35 weeks gestation (late preterm), RDS remains highly prevalent. Recent research confirms that RDS at 34-36 weeks is strongly associated with increased morbidity and mortality, including higher rates of intraventricular hemorrhage, retinopathy of prematurity, and neonatal sepsis. 2 The 4-week latency period (31 to 35 weeks) in this case increases the risk of pulmonary complications due to prolonged oligohydramnios exposure during critical lung development. 1
Why Not the Other Options?
Neonatal sepsis (Option A): While infection risk is elevated with PPROM, the incidence ranges from 5-25%, making it less common than RDS. 1 Antibiotics administered during expectant management (recommended for PPROM <34 weeks) reduce neonatal sepsis risk. 1
Skeletal deformities (Option B): These occur in only 5-25% of cases and are less common than respiratory complications. 1 Skeletal deformities require severe, prolonged oligohydramnios, typically from earlier PPROM (previable/periviable periods). 1
Critical Clinical Pitfall
Do not underestimate respiratory complications in late preterm births following PPROM. Even at 35 weeks, these neonates require close respiratory monitoring and may need surfactant therapy, mechanical ventilation, or NICU admission. 2 The combination of prematurity and prolonged oligohydramnios creates a "double hit" to lung development that manifests as RDS in the immediate neonatal period and chronic respiratory problems extending into childhood. 1
Answer: C - Respiratory distress syndrome