RETIRED: Magnesium Sulphate for Fetal Neuroprotection

Abstract

This document reflects emerging clinical and scientific advances on the date issued, and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC. AbstractObjective: To provide guidelines for the use of antenatal magnesium sulphate (MgSO 4 ) for fetal neuroprotection of the preterm infant .Options: Antenatal MgSO 4 administration should be considered for fetal neuroprotection when women present at ≤ 31+6 weeks with imminent preterm birth, defined as a high likelihood of birth because of active labour with cervical dilatation ≥ 4 cm, with or without preterm pre-labour rupture of membranes, and/or planned preterm birth for fetal or maternal indications .There are no other known fetal neuroprotective agents .Outcomes: The outcomes measured are the incidence of cerebral palsy (CP) and neonatal death . Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1) .Benefits, harms, and costs: Antenatal magnesium sulphate for fetal neuroprotection reduces the risk of "death or CP" (RR 0 .85; 95% CI 0 .74 to 0 .98; 4 trials, 4446 infants), "death or moderatesevere CP" (RR 0 .85; 95% CI 0 .73 to 0 .99; 3 trials, 4250 infants), "any CP" (RR 0 .71; 95% CI 0 .55 to 0 .91; 4, trials, 4446 infants), "moderate-to-severe CP" (RR 0 .60; 95% CI 0 .43 to 0 .84; 3 trials, 4250 infants), and "substantial gross motor dysfunction" (inability to walk without assistance) (RR 0 .60; 95% CI 0 .43 to 0 .83; 3 trials, 4287 women) at 2 years of age . Results were consistent between trials and across the meta-analyses . There is no anticipated significant increase in health care-related costs, because women eligible to receive antenatal MgSO 4 will be judged to have imminent preterm birth .

Update on the use of magnesium sulphate for fetal neuroprotection in preterm birth.

“…25 In addition, randomized studies using magnesium sulphate for neuroprotection did not affect the incidence of the Apgar score <7 at 5 minutes (RR: 1.03, 95% CI: 0.9-1.18, three studies, 4387 newborn infants), neonatal hypotonia (RR: 1.02, 95% CI: 0.77-1.36, one study, 2444 newborn infants) or mechanical ventilation requirement (RR: 0.94, 95% CI: 0.89-1.00; three studies, 4387 newborn infants). 3 In turn, a subanalysis of the BEAM study (Beneficial Effects of Antenatal Magnesium Sulphate Trial) found no correlation between the magnesium level in umbilical cord blood and the requirement of ventilation, intubation or chest compressions. 3 In addition, there were no differences in terms of seizures, respiratory distress syndrome, bronchopulmonary dysplasia or necrotizing enterocolitis.…”

“…3 In turn, a subanalysis of the BEAM study (Beneficial Effects of Antenatal Magnesium Sulphate Trial) found no correlation between the magnesium level in umbilical cord blood and the requirement of ventilation, intubation or chest compressions. 3 In addition, there were no differences in terms of seizures, respiratory distress syndrome, bronchopulmonary dysplasia or necrotizing enterocolitis. …”

“…Motor disorders of cerebral palsy are often accompanied b y d i s t u r b a n c e s o f s e n s a t i o n , perception, cognition, communication and behavior, by epilepsy and b y s e c o n d a r y m u s c u l o s k e l e t a l problems." 2 The prevalence of cerebral palsy is approximately 2-4/1000 live births 1,3 and its main risk factors include prematurity and multiple pregnancy. The incidence of prematurity is increasing; for example in the United States, it increased 36% between 1981 and 2008, and in Denmark it rose 22% between 1995 and 2004.…”

Recent Information on the Pathogenesis and Treatment of Hypoxic-Ischemic Brain Lesions in Newborns

“…Что касается клинических исследо-ваний, то применение сульфата магния у женщин с повы-шенным риском преждевременных родов значительно снижает риск церебрального паралича у их детей, не уве-личивая при этом риск смерти [137,138]. В Австралии в национальные клинические рекомендации введен при-ем сульфата магния беременной с 31-й нед гестации в случае угрозы преждевременных родов с целью нейро-протекции ребенка [139]. В то же время не подтвержда-ется, что магний может предотвращать сами преждевре-менные роды, либо облегчать их течение [138,140].…”

Effect of Magnesium Sulphate on Fetal Heart Rate Parameters: A Systematic Review

“…6 As such, EFM is recommended only for women with risk factors for adverse perinatal outcome, such as those requiring MgSO 4 for either prevention of eclampsia or fetal neuroprotection. 7 The use of MgSO 4 for fetal neuroprotection in the setting of imminent preterm birth for any indication at < 32 weeks is a relatively recent recommendation from the Society of Obstetricians and Gynaecologists of Canada, 7 and a Canadawide knowledge translation initiative has been undertaken within a quality assurance framework for tertiary obstetrical facilities. 8 This initiative has included educational site visits to these facilities, where questions were raised by physicians, midwives, and nurses about the effects of MgSO 4 on EFM, especially related to FHR variability.…”