Respiratory Distress Syndrome (RDS) is the Most Common Neonatal Complication
The correct answer is C - Respiratory distress syndrome (RDS), which occurs in up to 50% of neonates born after PPROM, making it the most common complication in this clinical scenario. 1
Comparative Incidence of Complications After PPROM
The evidence clearly establishes a hierarchy of complication frequencies:
Respiratory complications (RDS and bronchopulmonary dysplasia) occur in up to 50% of neonates born after PPROM, representing the highest incidence among all complications 1
Neonatal sepsis occurs in only 5-25% of cases after PPROM, making it substantially less common than respiratory complications 1
Skeletal deformities similarly occur in 5-25% of cases, placing them in the same lower-frequency category as sepsis 1
Other complications including intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity also occur in 5-25% of cases 1
Why RDS Predominates in This Clinical Context
The pathophysiologic mechanism explains the high incidence:
Prolonged oligohydramnios from PPROM at 31 weeks directly impairs fetal lung development, resulting in pulmonary hypoplasia, impaired surfactant production, and reduced alveolar development 1
At 35 weeks gestation (late preterm), the lungs remain vulnerable despite approaching term, particularly after 4 weeks of oligohydramnios exposure 1
RDS at 35-36 weeks carries significant morbidity, with associated increased risks of necrotizing enterocolitis, intraventricular hemorrhage, sepsis, neonatal death, and prolonged hospitalization 2
Clinical Management Implications
The American College of Obstetricians and Gynecologists provides specific guidance:
Close respiratory monitoring is essential for all neonates born at 35 weeks after PPROM 1
Prepare for possible surfactant therapy, mechanical ventilation, or NICU admission as these interventions are frequently required 1
The long-term impact is substantial: 50% of children at age 2 years and 57% at age 5 years continue requiring respiratory medications after being born with RDS 1
Common Pitfall to Avoid
While neonatal sepsis is an important concern in PPROM (and antibiotics are strongly recommended to reduce this risk 3), clinicians should not assume sepsis is the most common complication. The data unequivocally shows respiratory distress syndrome occurs 2-10 times more frequently than sepsis in this population 1. The focus should be on respiratory preparedness while maintaining vigilance for infectious complications.