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To the Editor.—Dr Mercer and colleagues of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network¹ have recently recommended that women with expectantly managed preterm premature rupture of membranes (PPROM) remote from term (32 weeks) should receive a specific regimen of antimicrobials to reduce infant morbidity. Whereas we applaud their efforts, we cannot agree that the conclusion should necessarily follow from their results given contemporary perinatal practice.

Prominent among their positive outcomes was a reduction in respiratory distress, and impressions of overall sepsis and neonatal pneumonia and the occurrence of necrotizing enterocolitis could conceivably all be a function of respiratory compromise. Hence, the overall outcome could be heavily influenced by the respiratory illness alone. In this regard, the study exclusion criteria not permitting corticosteroid and tocolytic therapy should be highlighted. Indeed, the study's data monitoring committee concluded after interim analyses that patient enrollment be . . . [Full Text of this Article]