Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus

Abstract

The neuroprotective role for antenatal magnesium sulphate therapy given to women at risk of preterm birth for the preterm fetus is now established. The number of women needed to be treated to benefit one baby by avoiding cerebral palsy is 63 (95% confidence interval 43 to 87). Given the beneficial effects of magnesium sulphate on substantial gross motor function in early childhood, outcomes later in childhood should be evaluated to determine the presence or absence of later potentially important neurological effects, particularly on motor or cognitive function.

Antenatal Magnesium Sulfate for Preterm Neuroprotection: A Single-Center Experience from Kuwait Tertiary NICU

“…We did not find any other neonatal adverse effect attributable to magnesium consistent with other studies and meta-analysis [ 7 , 8 , 13 , 25 ]. Interestingly, in our cohort, neonates exposed to antenatal MgSO 4 experienced significantly lesser hypotension in the immediate postnatal period and required lesser vasopressor support.…”

“…We did multivariate logistic regression analysis for known confounding variables (gestational age, birth weight, and resuscitation) and found the result to be valid. Our neurodevelopment follow-up showed an improved motor score of BSID at 3 completed years in MgSO4 exposed neonates, which is significant even on multivariate regression consistent with all other meta-analysis suggesting a reduction in CP [ 7 , 8 , 13 ]. Additionally, we found improved cognitive scores on a follow-up which was also significant in regression analysis.…”

Antenatal Magnesium Sulfate for Preterm Neuroprotection: A Single-Center Experience from Kuwait Tertiary NICU

“…We did not find any other neonatal adverse effect attributable to magnesium consistent with other studies and meta-analysis [ 7 , 8 , 13 , 25 ]. Interestingly, in our cohort, neonates exposed to antenatal MgSO 4 experienced significantly lesser hypotension in the immediate postnatal period and required lesser vasopressor support.…”

“…We did multivariate logistic regression analysis for known confounding variables (gestational age, birth weight, and resuscitation) and found the result to be valid. Our neurodevelopment follow-up showed an improved motor score of BSID at 3 completed years in MgSO4 exposed neonates, which is significant even on multivariate regression consistent with all other meta-analysis suggesting a reduction in CP [ 7 , 8 , 13 ]. Additionally, we found improved cognitive scores on a follow-up which was also significant in regression analysis.…”

The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China

“…Brookfield et al [19] reported that the use of prenatal MgSO 4 for fetal neuroprotection before 32 weeks of pregnancy at standard dose protocol improved neonatal neurological outcomes, but there is currently no evidence that it reduces neonatal mortality. We did not find a lower rate of severe brain injury with administration of MgSO 4 , which is consistent with the report of Doyle et al [8]. In this study, since MgSO 4 was defined as the use of magnesium sulfate before delivery for any reason, and not only neuroprotection, it is possible that this may have diluted the results.…”

Magnesium Decreases Inflammatory Cytokine Production: A Novel Innate Immunomodulatory Mechanism

“…In contrast, high TLR ligand concentrations abrogate the magnesium effect. These findings are consistent with clinical observations demonstrating that MgSO 4 is not associated with increased maternal or neonatal mortality, particularly that secondary to infection (8). …”

“…This knowledge led us to hypothesize that MgSO 4 exerts its neuroprotective effect by downregulating inflammatory cytokine production. Our results support our hypothesis and correlate with the findings of clinical trials where MgSO 4 treatment reduced the risk of cerebral palsy and major motor dysfunction in preterm infants (3–8). Importantly, we confirm the efficacy of MgSO 4 at reducing inflammation in preterm neonates, the population at highest risk for the development of cerebral palsy.…”

Antenatal Magnesium Sulfate for Preterm Neuroprotection: A Single-Center Experience from Kuwait Tertiary NICU

“…We did not find any other neonatal adverse effect attributable to magnesium consistent with other studies and meta-analysis [ 7 , 8 , 13 , 25 ]. Interestingly, in our cohort, neonates exposed to antenatal MgSO 4 experienced significantly lesser hypotension in the immediate postnatal period and required lesser vasopressor support.…”

“…We did multivariate logistic regression analysis for known confounding variables (gestational age, birth weight, and resuscitation) and found the result to be valid. Our neurodevelopment follow-up showed an improved motor score of BSID at 3 completed years in MgSO4 exposed neonates, which is significant even on multivariate regression consistent with all other meta-analysis suggesting a reduction in CP [ 7 , 8 , 13 ]. Additionally, we found improved cognitive scores on a follow-up which was also significant in regression analysis.…”

The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China

“…Brookfield et al [19] reported that the use of prenatal MgSO 4 for fetal neuroprotection before 32 weeks of pregnancy at standard dose protocol improved neonatal neurological outcomes, but there is currently no evidence that it reduces neonatal mortality. We did not find a lower rate of severe brain injury with administration of MgSO 4 , which is consistent with the report of Doyle et al [8]. In this study, since MgSO 4 was defined as the use of magnesium sulfate before delivery for any reason, and not only neuroprotection, it is possible that this may have diluted the results.…”

Magnesium Decreases Inflammatory Cytokine Production: A Novel Innate Immunomodulatory Mechanism

“…In contrast, high TLR ligand concentrations abrogate the magnesium effect. These findings are consistent with clinical observations demonstrating that MgSO 4 is not associated with increased maternal or neonatal mortality, particularly that secondary to infection (8). …”

“…This knowledge led us to hypothesize that MgSO 4 exerts its neuroprotective effect by downregulating inflammatory cytokine production. Our results support our hypothesis and correlate with the findings of clinical trials where MgSO 4 treatment reduced the risk of cerebral palsy and major motor dysfunction in preterm infants (3–8). Importantly, we confirm the efficacy of MgSO 4 at reducing inflammation in preterm neonates, the population at highest risk for the development of cerebral palsy.…”

Antenatal Magnesium Sulfate for Preterm Neuroprotection: A Single-Center Experience from Kuwait Tertiary NICU

“…We did not find any other neonatal adverse effect attributable to magnesium consistent with other studies and meta-analysis [ 7 , 8 , 13 , 25 ]. Interestingly, in our cohort, neonates exposed to antenatal MgSO 4 experienced significantly lesser hypotension in the immediate postnatal period and required lesser vasopressor support.…”

“…We did multivariate logistic regression analysis for known confounding variables (gestational age, birth weight, and resuscitation) and found the result to be valid. Our neurodevelopment follow-up showed an improved motor score of BSID at 3 completed years in MgSO4 exposed neonates, which is significant even on multivariate regression consistent with all other meta-analysis suggesting a reduction in CP [ 7 , 8 , 13 ]. Additionally, we found improved cognitive scores on a follow-up which was also significant in regression analysis.…”

The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China

“…Brookfield et al [19] reported that the use of prenatal MgSO 4 for fetal neuroprotection before 32 weeks of pregnancy at standard dose protocol improved neonatal neurological outcomes, but there is currently no evidence that it reduces neonatal mortality. We did not find a lower rate of severe brain injury with administration of MgSO 4 , which is consistent with the report of Doyle et al [8]. In this study, since MgSO 4 was defined as the use of magnesium sulfate before delivery for any reason, and not only neuroprotection, it is possible that this may have diluted the results.…”

Magnesium Decreases Inflammatory Cytokine Production: A Novel Innate Immunomodulatory Mechanism

“…In contrast, high TLR ligand concentrations abrogate the magnesium effect. These findings are consistent with clinical observations demonstrating that MgSO 4 is not associated with increased maternal or neonatal mortality, particularly that secondary to infection (8). …”

“…This knowledge led us to hypothesize that MgSO 4 exerts its neuroprotective effect by downregulating inflammatory cytokine production. Our results support our hypothesis and correlate with the findings of clinical trials where MgSO 4 treatment reduced the risk of cerebral palsy and major motor dysfunction in preterm infants (3–8). Importantly, we confirm the efficacy of MgSO 4 at reducing inflammation in preterm neonates, the population at highest risk for the development of cerebral palsy.…”