Antenatal Magnesium Sulfate and Neurologic Outcome in Preterm Infants

Doyle, Lex W.; Crowther, Caroline A; Middleton, Philippa; Marret, Stéphane

doi:10.1097/aog.0b013e3181a60495

Cited by 125 publications

(32 citation statements)

References 28 publications

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“…Supporting this, there is now evidence from meta-analyses of randomized controlled trials that antenatal administration of MgSO 4 is associated with a small but significant reduction in the risk of cerebral palsy and gross motor dysfunction in early childhood after preterm birth [7,8]. These meta-analyses included women in labor or at high risk of labor at ≤33 weeks gestation that received loading doses of 4-6 g of MgSO 4 i.v.…”

Section: Introductionmentioning

confidence: 99%

Magnesium Is Not Consistently Neuroprotective for Perinatal Hypoxia-Ischemia in Term-Equivalent Models in Preclinical Studies: A Systematic Review

et al. 2014

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There is an important unmet need to further improve the outcome of neonatal encephalopathy in term infants. Meta-analyses of large controlled trials now suggest that maternal magnesium sulfate (MgSO₄) therapy is associated with a reduced risk of cerebral palsy and gross motor dysfunction after premature birth, but that it has no effect on death or disability. Because of this inconsistency, it remains controversial whether MgSO₄ is clinically neuroprotective and, thus, it is unclear whether it would be appropriate to test MgSO₄ for treatment of encephalopathy in term infants. We therefore systematically reviewed the preclinical evidence for neuroprotection with MgSO₄ before or after hypoxic-ischemic encephalopathy (HIE) in term-equivalent perinatal and adult animals. The outcomes were highly inconsistent between studies. Although there were differences in dose and timing of administration, there was evidence that beneficial effects of MgSO₄ were associated with confounding mild hypothermia and, strikingly, the studies that included rigorous maintenance of environmental temperature or body temperature consistently suggested a lack of effect. On balance, these preclinical studies suggest that peripherally administered MgSO₄ is unlikely to be neuroprotective. Rigorous testing in translational animal models of perinatal HIE is needed before MgSO₄ should be considered in clinical trials for encephalopathy in term infants.

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Section: Introductionmentioning

confidence: 99%

Magnesium Is Not Consistently Neuroprotective for Perinatal Hypoxia-Ischemia in Term-Equivalent Models in Preclinical Studies: A Systematic Review

et al. 2014

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“…During this time of surveillance, maternal contributors should be minimised and medical condition optimised. When delivery is anticipated before 34 weeks gestation, antenatal corticosteroids should be administered, and if delivery is to occur at less than 30 weeks gestation, magnesium sulphate should be administered for protection against cerebral palsy 29 .…”

Section: Ultrasound Surveillance Of the Growth Restricted Fetusmentioning

confidence: 99%

The role of ultrasound in the diagnosis and management of the growth restricted fetus

Walker

2010

Australas J Ultrason Med

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“…Plusieurs méta-analyses ont été effectuées [13][14][15][16]. Elles confirment les tendances observées dans les divers essais et permettent d'affirmer que le sulfate de magnésium, donné aux mères en menace d'accouchement prématuré, diminue significativement les séquelles neuromotrices graves à type de PC observées entre 18 et 24 mois (risque relatif : 0,69, intervalle de confiance 95 % : [0,54-0,87]).…”

Section: Résultats Des Méta-analysesunclassified

Intérêt du sulfate de magnésium dans la prévention de la paralysie cérébrale de l’enfant né prématuré

Marret¹

2010

Rev. med. perinat.

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Plusieurs méta-analyses de cinq essais randomisés utilisant le sulfate de magnésium en anténatal chez la femme en menace d'accouchement prématuré sévère ont été faites. Elles confirment les tendances observées dans les différents essais et permettant d'affirmer que le sulfate de magnésium diminue de façon significative les taux de paralysie cérébrale (PC) observés entre 18 et 24 mois (risque relatif : 0,69, intervalle de confiance 95 % : [0,54-0,87]). Pour prévenir une PC chez un enfant, il faut traiter 63 mères qui vont accoucher prématurément avant le terme de 33-34 semaines et 29 mères avant le terme de 28 semaines. De plus, cette molécule entraîne une réduction significative de la préva-lence des difficultés motrices ainsi qu'une diminution des taux du critère combinant mortalité pédiatrique et PC à deux ans dans les quatre essais programmés à visée neuroprotectrice. Chez les enfants, les taux de mortalité pédiatrique n'étaient pas modifiés, et aucun effet délétère significatif n'était observé. Chez les mères, des effets secondaires mineurs à type de flush, tachycardie, voire hypotension arté-rielle étaient rapportés plus souvent avec le magnésium, mais disparaissaient à l'arrêt du traitement. Il n'y avait, par contre, aucune différence dans les taux de mort maternelle et/ou d'arrêt cardiorespiratoire. Pour citer cette revue : Rev. Méd. Périnat. 2 (2010).Mots clés Prématuré · Paralysie cérébrale · Leucomalacie périventriculaire · Essai randomisé · Anti-inflammatoire · Sulfate de magnésium · Neuroprotection Abstract This review concentrates on best evidence emerging in recent years on cerebral palsy prevention by administration of magnesium sulphate in mothers being at risk of preterm birth before 33-34 weeks' gestation. It has been shown in the Cochrane database and in three meta-analysis of five randomised trials (Magpie Trial [neuroprotection of the preeclamptic mother], MagNet [neuroprotection/other intent: tocolysis], ACTOMgSO 4 [neuroprotection], PRE-MAG [neuroprotection] and BEAM [neuroprotection]) that prenatal low-dose of magnesium sulphate given to mothers at risk of preterm birth has no severe deleterious effects in mothers and does not increase paediatric mortality in verypreterm infants. Moreover, it has a significant neuroprotective effects on occurrence of cerebral palsy at two years of age (with a 0.69 relative risk and a 95% confidence interval 0.54-0.87) and, in the neuroprotection subgroup, on the combined outcome of pediatric mortality or cerebral palsy (with a 0.85 relative risk and a 95% confidence interval: 0.74-0.98). The number needed to treat (NNT) to prevent one case of cerebral palsy was 63 (95% CI: 39 to 172) and the NNT for an extra survivor free of cerebral palsy in the neuroprotection subgroup was 41 (95% CI: 22 to 357), justifying that magnesium sulphate should be discussed as a stand-alone treatment or as part of a combination treatment. To cite this journal: Rev. Méd. Périnat. 2 (2010).

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Antenatal Magnesium Sulfate and Neurologic Outcome in Preterm Infants

Abstract: Antenatal magnesium sulfate therapy given to women at risk of preterm birth is neuroprotective against motor disorders in childhood for the preterm fetus.

Cited by 125 publications

References 28 publications

Magnesium Is Not Consistently Neuroprotective for Perinatal Hypoxia-Ischemia in Term-Equivalent Models in Preclinical Studies: A Systematic Review

Magnesium Is Not Consistently Neuroprotective for Perinatal Hypoxia-Ischemia in Term-Equivalent Models in Preclinical Studies: A Systematic Review

The role of ultrasound in the diagnosis and management of the growth restricted fetus

Intérêt du sulfate de magnésium dans la prévention de la paralysie cérébrale de l’enfant né prématuré

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