Magnesium Sulfate and Novel Therapies to Promote Neuroprotection (original) (raw)
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Magnesium Sulfate: Fetal Neuroprotective Role in Reducing the Risk of Cerebral Palsy
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2013
Advances in perinatal and neonatal medicine have significantly improved survival rates of preterm infants. This improvement has been associated with substantial risk of neurodevelopmental impairments and with increased number of infants with special health care needs. Cerebral palsy is the most well known and potentially most disabling motor abnormality associated with prematurity. There has been limited progress in understanding the causes of cerebral palsy and in developing primary prevention strategies. Several studies have summarized the experimental evidence that supports possible neuroprotective effects of magnesium. Five randomized controlled trials of antenatal magnesium sulfate found a trend of reduced risk of cerebral palsy in preterm infants. Three meta-analyses using the data from these five trials found that magnesium sulfate given to women at risk of premature birth significantly reduced the risk of cerebral palsy without increasing the risk of perinatal or infant deat...
Scientific Reports, 2015
The aim of our study was to assess the feasibility of implementing a protocol for the use of magnesium sulfate to prevent cerebral palsy. This retrospective single-center study included all women with fetuses of gestational age <33 weeks of gestation whose birth was planned or expected within 24 hours from September 2011 to December 2012. They were to receive magnesium sulfate, administered intravenously as a 4-g bolus followed by a constant infusion of 1 g per hour. If delivery had not occurred after 12 hours and was no longer considered imminent, the infusion was to be discontinued. The study included 119 women, 81 (68.1%) of whom received magnesium sulfate. Among the latter, 71 (87.5%) gave birth within 24 hours. The reasons treatment was not given were: omission by medical team (19/38, 50%), urgent delivery (18/38, 47.4%), and contraindication to treatment (1/38, 2.6%). The mean gestational age at protocol implementation was 29.6 +/− 2.1 weeks. Maternal monitoring, especially at the onset of infusion, appeared suboptimal. No major maternal side effects were observed. Our study shows that implementing a protocol for prevention of cerebral palsy by magnesium sulfate is feasible in a tertiary obstetric center.
Antenatal Magnesium Sulfate and Neurologic Outcome in Preterm Infants
Obstetrics & Gynecology, 2009
To systematically review rates of neurologic outcomes reported in childhood for the preterm fetus exposed to antenatal magnesium sulfate. DATA SOURCES: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, CENTRAL (The Cochrane Library 2008, Issue 3), relevant references from retrieved articles, and abstracts submitted to major congresses. METHODS OF STUDY SELECTION: We sought all randomized controlled trials (RCTs) of antenatal magnesium sulfate with neurologic outcomes reported for the fetus. TABULATION, INTEGRATION, AND RESULTS: Five eligible RCTs with 6,145 fetuses were identified; in four studies (4,446 fetuses) the primary intent was neuroprotection of the fetus. Methods of the Cochrane Collaboration were used to analyze the data. Antenatal magnesium sulfate therapy given to women at risk of preterm birth substantially reduced the risk of cerebral palsy in their children (relative risk [RR] 0.69; 95% confidence interval [CI] 0.54-0.87; five trials; 6,145 infants). The See related editorial on page 1202.
Journal of Medical Sciences
Objective The study aimed to find the effect of 4 grams of intravenous bolus antenatal dose of magnesium Sulphate on maternal and neonatal outcomes in preterm births. Material and Methods In a one-year cross-sectional descriptive study, patients with active preterm labor or those with planned preterm birth at 28-34 weeks of gestation were included. Antenatal magnesium Sulphate was administered as a 4gm IV loading dose over 30 minutes. The data was analyzed with SPSS (version 20), where mean ± standard deviation was used for numerical variables and frequency and percentages for categorical variables. The sample size was 88. A P value <_0.05 is used as a threshold for statistical significance. Results The mean age of patients was 28.78 (± SD of 6.038) and the mean period of gestation remained 32.04 (±1.868). Similarly, the mean cervical dilatation at which magnesium Sulphate was given was 6.591 (±1.358), the mean baby’s weight was 1.655 (±0.508) kg, and the mean Apgar score at 5 ...
Antenatal Magnesium Sulphate (Mgso4) for Fetal NeuroProtection Prior to Preterm Labor: Mini-Review
ARC Journal of Gynecology and Obstetrics, 2017
Cerebral palsy (CP) is a motor and/or cognitive dysfunction affecting the low birth weight (LBW) infants, and infants delivered preterm before 34 gestational weeks [4]. Many authors recommended the Magnesium Sulphate (MgSO4) infusion for prevention of CP in preterm infants delivered before 34 gestational weeks` [5]. Although; Magpie trial, concluded that the lower risk of eclampsia following prophylaxis with MgSO4 was not associated with a clear decrease in the risk of death or disability for infants at 18 months [6]. A Cochrane meta-analysis reported that the antenatal MgSO4 infusion before 37 gestational weeks to women at risk of PTL associated with reduced CP risk in their children (RR 0.68, CI; 0.54-0.87) [3]. So; this mini-review article designed to highlight the value of antenatal Magnesium Sulfate (MgSO4) infusion before 34 gestational weeks` in reduction of the cerebral palsy incidence associated with preterm labor (PTL), and low birth weight (LBW).
The Journal of Obstetrics and Gynecology of India, 2021
Background Survival of preterm infants has improved drastically. In addition to significant contribution to neonatal mortality, impact of prematurity among survivors may continue through life impairing long-term physical life through neuro-disability and increased risk of cerebral palsy. Maternal administration of magnesium sulfate prior to impending preterm birth is an effective strategy to reduce neuromorbidity. Aim To investigate the effectiveness of antenatal magnesium sulfate for neuroprotection in preterm infants between 26 and 34 weeks in preventing early neonatal morbidity and mortality. Secondary objective was to assess any adverse events with the use of magnesium sulfate on the mother and neonate. Method This was a prospective observational comparative study for 2 years at our tertiary care hospital of 100 pregnant women who gave preterm births. Fifty infants each were born to mothers who were either not given MgSO 4 (Group 1) or given 4gm intravenous loading dose MgSO 4 (Group 2), preferably 4 h prior to preterm birth. Results Among all the preterm in our study, 81% delivered between 30 and 34 weeks. There was no significant difference in terms of maternal mortality or serious morbidity including postpartum hemorrhage, caesarian section rates or length of hospital stay among women receiving MgSO 4 versus no MgSO 4. Mild maternal side effects secondary to magnesium sulfate were experienced in 8% cases. There were no significant differences between both groups for low 5 min APGAR, need for NICU admission, neonatal convulsions, hyperbilirubinemia, necrotizing enterocolitis, periventricular leukomalacia and septicemia. There was a trend toward reduced risk in the magnesium sulfate group for need for mechanical ventilation and ongoing respiratory support, intraventricular hemorrhage, neonatal hypotension, hypothermia, length of NICU stay. IVH was less frequent and less severe in babies exposed to antenatal MgSO 4 (8%) as compared to non-MgSO 4 group (16%). Neonatal morbidities were more when antenatal MgSO 4 was given less than 4 h from delivery. Conclusion MgSO 4 is a safe drug to use in antenatal women at risk for impending preterm. Antenatal magnesium sulfate given to women in established preterm labor conferred significant neuroprotective advantage to the neonate. MgSO 4 also has protective effect on the need of invasive ventilatory support in preterm infants. Given the breadth of evidence in its favor, it is time for us to start using MgSO 4 in clinical practice for neuroprotective intent in all our extreme preterm births.