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Clinical Obstetrics

Poster Session 4

(961) Predictive value of neutrophil-lymphocyte ratio for intraamniotic infection in preterm premature rupture of membranes

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

The purpose of our study is to assess whether an elevated neutrophil-lymphocyte ratio (NLR) is associated with intraamniotic infection (Triple I) in patients with preterm premature rupture of membranes (PPROM) and subsequent adverse neonatal outcomes.

Study Design:

We conducted a retrospective cohort study focused on women diagnosed with PPROM before 34 weeks, with or without Triple I based on ICD-10 codes at a tertiary US hospital. The NLR was calculated from complete blood counts obtained prior to delivery. Triple I was defined as maternal temperature ≥39.0°C or 38.0–38.9°C accompanied by at least one additional clinical risk factor such as maternal leukocytosis, fetal tachycardia, mucopurulent discharge, or uterine tenderness. Fetal outcomes included respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage, sepsis, and mortality. T-test was used to determine the association between NLR and intraamniotic infection and neonatal outcomes.

Results:

One hundred and thirty-three women were diagnosed with PPROM. Forty-six out of the 133 (34.6%) women were diagnosed with Triple I at the time of delivery. Patients diagnosed with triple I had higher mean NLR compared to PPROM patients without triple I [p=0.026]. Patients with fever had a significantly elevated NLR when compared to patients without fever [mean: 11.1 vs 5.8, SD: 1.9 vs 0.4, p< 0.001]. A similar trend was observed with maternal leukocytosis [10.1 vs 5.3, 1.2 vs 0.4, p< 0.001] and fetal tachycardia [8.9 vs 6.5, 2.2 vs 0.5, p=0.111]. However, an elevated NLR was not associated with mucopurulent discharge, uterine tenderness, or adverse neonatal outcomes in this population when controlled for gestational age.

Conclusion:

Patients with PPROM and an elevated NLR have an increased risk of Triple I and should be closely monitored for symptoms. However, the NLR did not have any predictive value of adverse neonatal outcomes in this population.