Magnesium therapy in premature neonates with apnea neonatorum.

Abstract

Apnea, bradycardia, and neuromuscular hyperirritability have been associated with magnesium (Mg) deficiency in young human infants and weanling animals. This is a retrospective review of a clinical experience of Mg therapy among 200 premature neonates who showed physical and clinical chemical changes compatible with Mg deficiency. The 200 infants all had idiopathic apnea neonatorum, and 93% also had the respiratory distress syndrome (RDS). This review was conducted to learn whether Mg therapy was associated with a significant reduction in apnea. The author suggested that the dose of Mg be 0.4 mEq/kg body weight/day, as 50% MgSO4.7H2O intramuscularly (IM) for 5 days; or as 1.0 mEq/kg/day, as 10% MgCl2.6H2O by mouth for 2 or more weeks, with appropriate monitoring of plasma Mg values in all infants. Sixty-one infants received a minimum of 5 days of Mg by either route (mean, 11.4 +/- 0.9, Group A); five received 3-4 doses IM (mean, 3.6 +/- 0.2, Group B); and 134 received 0-2 doses IM (0.5 +/- 0.1, Group C). Group A infants Mg-treated before Day 20 showed earlier cessation of apnea and bradycardia than those treated after Day 20. In Group A patients, 7 dose-days [corrected] of Mg therapy was associated with continuation of apnea; 14 dose-days [corrected], with cessation of apnea. Compared with Group A, Group C continued to develop apnea (P less than .003) and bradycardia (P less than 0.03) over longer periods of time. Group A infants showed no record of death or of hospital readmission for recurrent apnea, while 32 of 134 Group C infants had one or both of those unfavorable outcomes (P less than 0.001), with four of the five deaths in Group C (NS) as the sudden infant death syndrome (SIDS). In conclusion, Mg was associated with a reduction of apnea in this population. Emphasis was placed on the need to closely observe infants receiving supplementary Mg, with monitoring of plasma Mg levels.

Nutrient Requirements For Preterm Infant Formulas

“…Wirth et al (1990) fed 19 mg/100 kcal for 6 days to preterm-LBW infants without reports of adverse effects. Caddell (1988; administered 24 mg of magnesium during a 24-hour period, orally as the chloride, usually for 2 weeks, to 200 premature infants with apnea neonatorum. She reported that none of the infants showed signs of magnesium toxicity.…”

Consequences of magnesium deficiency on the enhancement of stress reactions; preventive and therapeutic implications (a review).

“…Miller et al [120] suggest that abnormal blood platelet activation may be a significant mortality risk factor in severe gestational and infantile Mg deficit and draw a parallel between the pathologic findings in Mg deficient lambs with those in the sudden infant death syndrome (SIDS). Caddell proposes that neonatal and postneonatal apnea and respiratory distress syndrome (RDS) are pre monitory findings in infants who are later victims of SIDS, and advises Mg treatment in doses low enough not to constitute a risk (0.4-1 mEq/kg/d for about 2 weeks) in RDS infants with immature kidneys [121][122][123]. Infants with RDS are most commonly born to mothers subject to hypomagnesemia [59,124].…”

Effects of hypomagnesemia on reactivity of bovine and ovine platelets: possible relevance to infantile apnea and sudden infant death syndrome.

“…1) and lambs in which intravascular clumping of platelets was induced by collagen injected intravenously [23] were markedly similar to lungs of an 11-week-old human infant diag nosed as a victim of SIDS [5]. Clinical experience with idiopathic apnea neonatorum [24] revealed no record of hospital readmission for recurrent apnea or death in 61 infants receiving Mg therapy (0.4 mEq intramuscularly as the sulfate or 1.0 mEq orally as the chloride/kg body weight/day) a minimum of 5 days. In contrast, among 134 infants receiving Mg less than 2 days (mean = 0.5 days), 32 developed recurrent apnea, of which four died of SIDS.…”