OBJECTIVE: To find association between fetal urine production rate (FUPR) and fetal inflammatory response syndrome (FIRS) in cases of preterm premature rupture of membranes (PPROM). DESIGN: Prospective cohort SETTING: Tertiary hospital SAMPLE: 70 pregnancies complicated by PPROM at 28-34 weeks. METHODS: Patients were managed conservatively till 34 weeks pregnancy or until spontaneous labor/chorioamnionitis. FUPR was calculated by doing serial fetal bladder volume measurements and was repeated weekly till patient delivered. During delivery, cord blood sample was taken for measuring Interleukin-6 (IL-6) levels. Placental tissue was examined for histopathologic evidence of FIRS and chorioamnionitis. Neonatal outcomes were noted as admission to NICU and severe neonatal morbidity. MAIN OUTCOME MEASURE: Measurement of FUPR antenatally and its association with development of FIRS in neonates. RESULTS: Overall prevalence of FIRS in cases of PPROM was 62.86%. Mean FUPR at time of delivery was significantly reduced in neonates with evidence of FIRS as compared to Non FIRS group (13.89±8.06 ml/h vs 25.89±4.94ml/h). Out of 41 patients with reduced FUPR prior to delivery, 39 babies had FIRS whereas only 5 out of 29 babies with normal FUPR, had FIRS (p value <0.0001). The rate of adverse neonatal morbidity was significantly high in neonates with reduced FUPR. CONCLUSION: Reduced FUPR is strongly associated with development of FIRS in cases of PPROM and hence can be used as an early predictor of adverse neonatal outcomes. FUNDING: Only institutional funds KEYWORDS: Preterm premature rupture of membrane, fetal urine production rate, fetal inflammatory response syndrome, interleukein-6 levels