Herman A. Hein, MD, Jonathan M. Klein and Robert D. Roghair, MD
Peer Review Status: Internally Peer Reviewed 2012

  • Prolonged rupture of membranes is arbitrarily defined as rupture of membranes for greater than 18 hours.
  • If asymptomatic, the infant should be observed in the hospital for 48 hours. Consider obtaining a screening CBC with differential at birth and at a minimum of 6- 12 hrs of life. 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 48 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, treat the infant with at least 48 hrs of antibiotics depending on labs, cultures and clinical course.
  • Flow sheet for management decisions