Antenatal Magnesium Sulfate Exposure and Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants

Abstract

Objective The use of antenatal magnesium sulfate (MgSO 4 ) has been associated with neuroprotective effects. One of its' proposed mechanisms of action includes antagonism of calcium channels. Calcium influx is important for closure of ductus arteriosus. We hypothesized that antenatal MgSO 4 exposure may be associated with an increased risk of hemodynamically significant patent ductus arteriosus (HsPDA) in premature infants (PI). Study Design A prospective cohort study conducted in two parts. PI (< 32 weeks and < 1,500 g) were recruited ( n = 105). All infants had Echocardiograph (ECHO; within 3 days) and blood samples drawn at the same time for B-type natriuretic peptide (BNP; part 1) and NTproBNP (N-terminal pro BNP; part 2) measurements. HsPDA was defined as a PDA diameter > 1.5 mm and BNP levels > 40 pg/mL or NTproBNP > 10,200 pg/mL. Infants were divided into two groups based on antenatal MgSO 4 exposure. Data were analyzed using SPSS 23. Difference in baseline characteristics and antenatal steroid use in the two groups was analyzed. A matched group analysis was performed to adjust for the difference in the numbers between the two groups. A p -value < 0.05 was considered significant. Results There was no significant difference seen in baseline characteristics or use of antenatal steroids in exposed versus unexposed ( n = 95 vs. n = 10). There was a significant negative correlation between antenatal MgSO 4 exposure and HsPDA in PI ( p ≤ 0.05). However, this association was not significant after matched group analysis. Conclusion Antenatal MgSO 4 exposure is not associated with an increased risk of HsPDA. It may be associated with a decreased likelihood of HsPDA.

Effects of antenatal magnesium sulfate use for neuroprotection on cardiorespiratory complications during the early neonatal period in preterm infants

“…However, in a study on cardiovascular effects of antenatal MgSO 4 , Paradisis et al [31] reported an incidental finding of significantly smaller PDA in the exposed group. Qasım et al [15] recently showed a decreasing trend of HsPDA with antenatal MgSO 4 exposure. In our study, antenatal MgSO 4 was associated with significantly decreased HsPDA.…”

“…Previous studies reported that antenatal MgSO 4 -exposed infants had an increased risk for hypotonia, delivery room intubation, and significant patent ductus arteriosus (PDA) compared with infants not exposed to antenatal MgSO 4 [11][12][13]. However, the cardiorespiratory effect of antenatal MgSO 4 in preterm infants is still controversial [14,15].…”

Identification of the hemodynamic significant patent ductus arteriosus in preterm infants

“…As a result, they found that magnesium sulfate exposure did not increase the incidence of hsPDA. Based on partial statistic findings there was a significant negative correlation between antenatal MgSO4 exposure and hsPDA, they speculated that antenatal MgSO4 exposure may play a role of helping with ductal closure [36] . Besides, Elena Fridman discovered maternal aspirin treatment may be associated with a decrease likelihood of hsPDA in preterm infant and may increase infant responsiveness to postnatal medical PDAtreatment [37] .…”

Molecular and Mechanical Mechanisms Regulating Ductus Arteriosus Closure in Preterm Infants

“…Antenatal MgSO 4 which is a calcium channel blocker may result in delayed ductal closure in infants ( 217 ). However, recent evidence in extremely low birth weight infants suggests that antenatal MgSO 4 exposure is not associated with an increased risk of hemodynamically significant PDA; in fact, it may be associated with a decreased likelihood of hemodynamically significant PDA ( 218 ). Diazoxide, which is a K ATP channel activator may induce ductal opening ( 173 ).…”