2 articles
Fetal hydrops is defined as the pathological accumulation of extracellular fluid in at least two fetal anatomical compartments, including skin edema (> 5 mm thickness), pericardial effusion, pleural effusion, and ascites. Non-immune fetal hydrops (NIHF) accounts for over 90% of all fetal hydrops cases and has a heterogeneous etiology. Congenital infections contribute to approximately 6–7% of NIHF cases and are associated with a severe neonatal prognosis.
A preterm newborn was delivered from a pregnancy complicated by untreated maternal primary syphilis. The fetus had been diagnosed antenatally with NIHF, heart failure, and massive ascites. Postnatally, the infant required early ascitic drainage and subsequently underwent surgery for congenital intestinal obstruction in the context of ileal stenosis. Neonatal serological testing revealed a positive rapid plasma reagin (RPR) and a reactive Treponema pallidum Hemagglutination Assay (TPHA). Management of congenital syphilis was carried out according to the standardized national clinical protocol. The collected data were compared with those reported in the existing literature to assess clinical significance.
The neonate showed a favorable clinical evolution following multidisciplinary management, including intensive care support, anti-infective therapy, and surgical correction of the intestinal obstruction. Progressive improvement allowed successful postoperative recovery and discharge in satisfactory condition.
Early identification of the infectious etiology of fetal hydrops is essential for the implementation of appropriate management and the improvement of neonatal outcomes. Close collaboration between maternal–fetal medicine, neonatology, and pediatric surgery is crucial in managing such complex cases.
Prolonged premature rupture of membranes predisposes to intrauterine infection and chorioamnionitis, both of which have significant implications for neonatal outcomes. While chorioamnionitis has been linked to accelerated surfactant production and reduced respiratory distress syndrome, it is also associated with long-term pulmonary injury, including bronchopulmonary dysplasia and pulmonary hypertension. The objective of the study is to investigate the association between prolonged premature rupture of membranes, chorioamnionitis, and respiratory outcomes among preterm infants ≤34 weeks of gestation.
A prospective cohort of 108 preterm infants admitted to the Neonatal Intensive Care Unit of the Mother and Child Institute, Chișinău, between October 2023 and July 2024, was divided into two groups: infants born to mothers with clinical/histological chorioamnionitis (n = 54) and controls (n = 54). Maternal risk factors, incidence of prolonged premature rupture of membranes incidence, Apgar scores, type and duration of respiratory support, and pulmonary complications were analyzed. Statistical significance was tested using chi-square and logistic regression.
Prolonged premature rupture of membranes was significantly more frequent in chorioamnionitis group (67% vs. 22%, p<0.001). Infants exposed to chorioamnionitis had lower 1-minute Apgar scores, greater need for invasive ventilation (5.9 ± 10.6 vs. 2.2 ± 4.8 days, p<0.05), and prolonged hospitalization. BPD incidence was higher in the chorioamnionitis group (25.9% vs. 3.7%, p<0.05). Mortality did not differ significantly between groups (27.8% vs. 22.2%).
Prolonged premature rupture of membranes is strongly associated with chorioamnionitis, which in turn significantly increases the risk of long-term pulmonary complications in preterm infants. Early recognition of prolonged premature rupture of membranes, antibiotic prophylaxis, antenatal corticosteroids, and interdisciplinary obstetric–neonatal management are essential to reduce the burden of bronchopulmonary dysplasia.