The Survey of Magnesium Sulfate in Prevention of Intraventricular Hemorrhage in Premature Infants: A Randomized Clinical Trial

Parashi, Shayesteh; Bordbar, Arash; Mahmoodi, Yaqoub; Jafari, Mahasa Rezaei

doi:10.5812/semj.55094

Cited by 4 publications

(4 citation statements)

References 24 publications

(28 reference statements)

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“…This comparison included 18 trials. The indication for use of magnesium sulphate in 6 trials was the prevention of eclampsia [30,32,39,43,48,61]; in 6 trials, fetal neuroprotection [28,36,45,47,51,54]; and in 6 trials, the prevention of preterm birth (tocolysis) [33–35,38,40,46]. Magnesium sulphate regimens assessed varied considerably: 4-gram IV loading dose only (2 trials), 4-gram IV loading dose and 1-gram-per-hour IV maintenance dose (4 trials), 4-gram IV loading dose and 2-gram-per-hour IV maintenance (4 trials), 6-gram IV loading dose and 2-gram-per-hour IV maintenance dose (6 trials), and 4-gram IV and 10-gram IM loading dose and 5-gram IM maintenance dose every 4 hours (2 trials), with duration of treatment generally ranging from 12 to 24 hours.…”

Section: Resultsmentioning

confidence: 99%

Antenatal magnesium sulphate and adverse neonatal outcomes: A systematic review and meta-analysis

et al. 2019

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Background There is widespread, increasing use of magnesium sulphate in obstetric practice for preeclampsia, eclampsia, and preterm fetal neuroprotection; benefit for preventing preterm labour and birth (tocolysis) is unproven. We conducted a systematic review and meta-analysis to assess whether antenatal magnesium sulphate is associated with unintended adverse neonatal outcomes. Methods and findings CINAHL, Cochrane Library, LILACS, MEDLINE, Embase, TOXLINE, and Web of Science, were searched (inceptions to 3 September 2019). Randomised, quasi-randomised, and non-randomised trials, cohort and case-control studies, and case reports assessing antenatal magnesium sulphate for pre-eclampsia, eclampsia, fetal neuroprotection, or tocolysis, compared with placebo/no treatment or a different magnesium sulphate regimen, were included. The primary outcome was perinatal death. Secondary outcomes included prespecified and non-pre-specified adverse neonatal outcomes. Two reviewers screened 5,890 articles, extracted data, and assessed risk of bias following Cochrane Handbook and RTI Item Bank guidance. For randomised trials, pooled risk ratios (RRs) or mean differences, with 95% confidence intervals (CIs), were calculated using fixed-or random-effects meta-analysis. Non-randomised data were tabulated and narratively summarised. We included 197 studies (40 randomised trials, 138 non-randomised studies, and 19 case reports), of mixed quality. The 40 trials (randomising 19,265 women and their babies) were conducted from 1987 to 2018 across high-(16 trials) and low/middle-income countries (23 trials) (1 mixed). Indications included pre-eclampsia/eclampsia (24 trials), fetal neuroprotection (7 trials), and tocolysis (9 trials); 18 trials compared magnesium sulphate with placebo/ no treatment, and 22 compared different regimens. For perinatal death, no clear difference in randomised trials was observed between magnesium sulphate and placebo/no treatment

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Section: Resultsmentioning

confidence: 99%

Antenatal magnesium sulphate and adverse neonatal outcomes: A systematic review and meta-analysis

et al. 2019

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“…In this systematic review and meta-analysis of 221 trials that assessed 44 perinatal interventions, we found with moderate certainty that antenatal corticosteroids for lung maturation (small decrease) and indomethacin prophylaxis (moderate decrease) were associated with reduced risk of sIVH in preterm neonates. We also found low certainty evidence that volume-targeted ventilation (large decrease), early ESAs (moderate decrease), and prophylactic ethamsylate (moderate decrease) were associated with lower risk of sIVH, whereas UCM (moderate increase) were associated with higher risk of sIVH in preterm neonates.…”

Section: Discussionmentioning

confidence: 93%

“…We further determined the eligibility of 395 short-listed articles and excluded 174 articles for the reasons shown in eAppendix 4 in Supplement 1. A total of 221 RCTs were included in the final sample . These trials evaluated 44 interventions, which included 6 antenatal, 6 delivery room, and 32 neonatal interventions.…”

Section: Resultsmentioning

confidence: 99%

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

et al. 2023

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ImportanceInterventions to reduce severe brain injury risk are the prime focus in neonatal clinical trials.ObjectiveTo evaluate multiple perinatal interventions across clinical settings for reducing the risk of severe intraventricular hemorrhage (sIVH) and cystic periventricular leukomalacia (cPVL) in preterm neonates.Data SourcesMEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched from inception until September 8, 2022, using prespecified search terms and no language restrictions.Study SelectionRandomized clinical trials (RCTs) that evaluated perinatal interventions, chosen a priori, and reported 1 or more outcomes (sIVH, cPVL, and severe brain injury) were included.Data Extraction and SynthesisTwo co-authors independently extracted the data, assessed the quality of the trials, and evaluated the certainty of the evidence using the Cochrane GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Fixed-effects pairwise meta-analysis was used for data synthesis.Main Outcomes and MeasuresThe 3 prespecified outcomes were sIVH, cPVL, and severe brain injury.ResultsA total of 221 RCTs that assessed 44 perinatal interventions (6 antenatal, 6 delivery room, and 32 neonatal) were included. Meta-analysis showed with moderate certainty that antenatal corticosteroids were associated with small reduction in sIVH risk (risk ratio [RR], 0.54 [95% CI, 0.35-0.82]; absolute risk difference [ARD], −1% [95% CI, −2% to 0%]; number needed to treat [NNT], 80 [95% CI, 48-232]), whereas indomethacin prophylaxis was associated with moderate reduction in sIVH risk (RR, 0.64 [95% CI, 0.52-0.79]; ARD, −5% [95% CI, −8% to −3%]; NNT, 20 [95% CI, 13-39]). Similarly, the meta-analysis showed with low certainty that volume-targeted ventilation was associated with large reduction in risk of sIVH (RR, 0.51 [95% CI, 0.36-0.72]; ARD, −9% [95% CI, −13% to −5%]; NNT, 11 [95% CI, 7-23]). Additionally, early erythropoiesis-stimulating agents (RR, 0.68 [95% CI, 0.57-0.83]; ARD, −3% [95% CI, −4% to −1%]; NNT, 34 [95% CI, 22-67]) and prophylactic ethamsylate (RR, 0.68 [95% CI, 0.48-0.97]; ARD, −4% [95% CI, −7% to 0%]; NNT, 26 [95% CI, 13-372]) were associated with moderate reduction in sIVH risk (low certainty). The meta-analysis also showed with low certainty that compared with delayed cord clamping, umbilical cord milking was associated with a moderate increase in sIVH risk (RR, 1.82 [95% CI, 1.03-3.21]; ARD, 3% [95% CI, 0%-6%]; NNT, −30 [95% CI, −368 to −16]).Conclusions and RelevanceResults of this study suggest that a few interventions, including antenatal corticosteroids and indomethacin prophylaxis, were associated with reduction in sIVH risk (moderate certainty), and volume-targeted ventilation, early erythropoiesis-stimulating agents, and prophylactic ethamsylate were associated with reduction in sIVH risk (low certainty) in preterm neonates. However, clinicians should carefully consider all of the critical factors that may affect applicability in these interventions, including certainty of the evidence, before applying them to clinical practice.

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“…Si la paciente cuenta con antecedentes de RPM se debe preparar a la madre para estar atenta frente a signo y síntomas que puedan sugerir la aparición de dicha entidad. Si la paciente ya cuenta con la instauración de la RPM, se debe iniciar antibioticoterapia profiláctica y corticoterapia de ser necesario (38).…”

Section: A6 -Prevenciónunclassified

Factores de riesgo asociados a la ruptura prematura de membrana en gestantes añosas atendidas en el servicio de gineco-obstetricia del Hospital de Huaycán, 2020

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Objetivo: Determinar los factores de riesgo asociados a la ruptura prematura de membrana en gestantes añosas atendidas en el servicio de gineco-obstetricia del Hospital de Huaycán durante el 2020. Materiales y métodos: Se realizó un estudio observacional, analítico de casos y controles, retrospectivo y la muestra estuvo conformada por 171 gestantes, seleccionados mediante un muestreo probabilístico aleatorio simple. Se utilizó como instrumento una ficha de recolección de datos y el análisis estadístico fue principalmente bivariado, haciendo uso del Odds Ratio (OR) para determinar los factores de riesgo, además del análisis descriptivo para determinar las medidas de tendencia central y de dispersión; así como las frecuencias absolutas y relativas. Resultados: La muestra estuvo caracterizada en su mayoría por gestantes entre 35 a 39 años (84,2%) y procedentes de Ate (78,9%). Respecto a las características sociodemográficas, la edad aumentó en 18 veces el riesgo de padecer ruptura prematura de membranas. Por otro lado, respecto a las características gineco-obstétricas, no se encontró que la cantidad de controles prenatales, la cantidad de gestaciones previas o el antecedente de RPM sean factores de riesgo. En cuanto a las comorbilidades, la infección del tracto urinario aumentó el riesgo en 2,4 veces más de tener RPM que aquellas que no presentaron esta condición durante el embarazo. Conclusiones: Existen factores de riesgo sociodemográficos y comorbilidades asociadas a la ruptura prematura de membranas. No existen factores gineco-obstétricos de riesgo para RPM en la población estudiada.

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The Survey of Magnesium Sulfate in Prevention of Intraventricular Hemorrhage in Premature Infants: A Randomized Clinical Trial

Cited by 4 publications

References 24 publications

Antenatal magnesium sulphate and adverse neonatal outcomes: A systematic review and meta-analysis

Antenatal magnesium sulphate and adverse neonatal outcomes: A systematic review and meta-analysis

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates

Factores de riesgo asociados a la ruptura prematura de membrana en gestantes añosas atendidas en el servicio de gineco-obstetricia del Hospital de Huaycán, 2020

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