AIM: To determine whether preterm premature rupture of membranes (PPROM) before 
24 weeks is an independent risk factor for poor outcome in preterm neonates.
METHODS: A retrospective comparative cohort study was conducted, including 
viable premature infants born between 25 and 34-weeks gestation. Each preterm 
case with early PPROM was matched with two preterm controls of the same 
gestational age at birth, sex and birth date and who were born spontaneously 
with intact membranes. Logistic regression was performed to identify independent 
risk factors associated with composite respiratory and perinatal adverse 
outcomes for the overall population of preterm infants.
RESULTS: Thirty-five PPROM cases were matched with 70 controls. Extreme 
prematurity (26-28 weeks) was an independent risk factor for composite perinatal 
adverse outcomes [odds ratio (OR) 43.9; p = 0.001]. Extreme prematurity (OR 
42.9; p = 0.001), PPROM (OR 7.1; p = 0.01), male infant (OR 5.2; p = 0.02) and 
intrauterine growth restriction (IUGR, OR 4.8; p = 0.04) were factors for 
composite respiratory adverse outcomes.
CONCLUSION: Preterm premature rupture of membranes before viability represents 
an independent risk factor for composite respiratory adverse outcomes in preterm 
neonates. Extreme prematurity may represent the main risk factor for both 
composite respiratory and perinatal adverse outcomes.