Antenatal Exposure to Magnesium Sulfate Is Associated with Reduced Cerebellar Hemorrhage in Preterm Newborns

Abstract

Objective To determine the association of antenatal magnesium sulfate with cerebellar hemorrhage in a prospective cohort of premature newborns evaluated by magnetic resonance imaging (MRI). Study design Cross-sectional analysis of baseline characteristics from a prospective cohort of preterm newborns (<33 weeks gestation) evaluated with 3T-magnetic resonance imaging (MRI) shortly after birth. Exclusion criteria were clinical evidence of a congenital syndrome, congenital infection, or clinical status too unstable for transport to MRI. Antenatal magnesium sulfate exposure was abstracted from the medical records and the indication was classified as obstetric or neuroprotection. Two pediatric neuroradiologists, blinded to the clinical history, scored axial T2-weighted and iron-susceptibility MRI sequences for cerebellar hemorrhage. The association of antenatal magnesium sulfate with cerebellar hemorrhage was evaluated using multivariable logistic regression, adjusting for postmenstrual age at MRI and known predictors of cerebellar hemorrhage. Results Cerebellar hemorrhage was present in 27/73 (37%) newborns imaged at a mean postmenstrual age of 32.4 ± 2 weeks. Antenatal magnesium sulfate exposure was associated with a significantly reduced risk of cerebellar hemorrhage. Adjusting for postmenstrual age at MRI, and predictors of cerebellar hemorrhage, antenatal magnesium sulfate was independently associated in our cohort with decreased cerebellar hemorrhage (OR 0.18, 95% CI 0.049–0.65, P=0.009). Conclusion Antenatal magnesium sulfate exposure is independently associated with a decreased risk of MRI-detected cerebellar hemorrhage in premature newborns, which could explain some of the reported neuroprotective effects of magnesium sulfate.

Incidence and Risk Factors for Hypoglycemia During Fetal-to-Neonatal Transition in Premature Infants

“…MgSO 4 administration was a protective factor for neonatal hypoglycemia in univariate analysis, but became non-significant in multivariate analysis. Antenatal MgSO 4 reduces incidence of cerebral palsy and hemorrhage in infants born preterm, regardless of total dose (19)(20)(21). MgSO 4 has been shown to decrease blood brain barrier permeability and increase plasma glucose concentration in a rat model of hypoglycemia (22).…”

Combined fetal inflammation and postnatal hypoxia causes myelin deficits and autism‐like behavior in a rat model of diffuse white matter injury

“…Functionally, WMI is associated with behavioral, cognitive, motor and psychological problems, like autism spectrum disorders (ASD), later in life (Back & Miller, ; Dudova et al, ; Guo et al, ; Johnson, Hollis, Kochhar, Hennessy, Wolke, & Marlow, ; Joseph et al, ; Kuzniewicz et al, ; Limperopoulos et al, ; Peyton et al, ; Pritchard et al, ; Treyvaud et al, ). While antenatal administration of magnesium sulfate in women at risk for preterm delivery reduces the risk of cerebral palsy in the fetus (Crowther, Hiller, Doyle, & Haslam, ; Doyle, Crowther, Middleton, Marret, & Rouse, ; Gano et al, ; Rouse et al, ), limited treatment options are currently available to protect preterm infants against diffuse WMI. Moreover, the mechanisms underlying diffuse WMI are not completely understood (van Tilborg et al, ).…”

Magnesium sulphate induces preconditioning in preterm rodent models of cerebral hypoxia‐ischemia

“…Randomized controlled trials have subsequently confirmed these results and a recent meta‐analysis demonstrated that the frequency of CP or moderate/severe motor disability was reduced by ∼30% by antenatal MgSO 4 (Doyle et al, 2009). Furthermore, the rate of echolucent and echodense brain lesions (Hirtz et al, 2015) as well as cerebellar hemorrhages (Gano et al, 2016) has been shown to be attenuated by antenatal MgSO 4 treatment.…”