Iowa Neonatology Handbook: Infection

Care of the Infant Born to a Mother with Prolonged Rupture of Membranes

Herman A. Hein, MD and Robert D. Roghair, MD
Peer Review Status: Internally Peer Reviewed

• Prolonged rupture of membranes is arbitrarily defined as rupture of membranes for greater than 12 hours.
• If asymptomatic, the infant should be observed in the hospital for 48 hours. A screening CBC with differential may be obtained at birth. If the infant shows clinical signs of illness, a sepsis work-up as outlined below should be performed.  
• If the infant shows clinical signs of illness, a sepsis work-up should be performed.
• If a sepsis work-up has been performed, the infant should be reassessed at 72 hours. One can consider discontinuing the antibiotics if the clinical course and lab results have not been suggestive of infection and the cultures are negative.
• If the blood culture is positive, treat for a minimum of 10 days.
• If the CSF culture is positive, treat for a minimum of 14-21 days.
• The attending neonatologist should be consulted regarding duration of therapy in all cases.
• If there is any evidence of chorioamnionitis along with the PROM, a sepsis work-up must be initiated and the baby begun on intravenous antibiotics as soon as possible. The length of antibiotic therapy should be based on the clinical course, lab results, cultures as well as the suspected etiology of maternal fever. The association of maternal fever with epidural analgesia is well known. Please note that if chorioamnionitis is suspected, it is not longer necessary to treat the infant with 10 days of antibiotics if there are no other associated findings pointing to sepsis in the infant.

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