Association between Serum Magnesium level and outcome in birth asphyxia (original) (raw)
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How serum magnesium level is related to severity of asphyxia
Ijrcog, 2024
Background: Perinatal asphyxia is a most common cause of neonatal death. Magnesium, the second most common intracellular cation, may play a role in neuroprotection. Methods: This observational study was undertaken in the Department of Gynecology and Pediatrics in GMC, Shahdol from January 2021 to June 2023. The term babies were included with congenital anomaly, diabetic mother, IUGR, and mother receiving magnesium therapy during labour were excluded. Data analysis was conducted using IBM SPSS statistical software (version 22.0). Results: Out of 46 newborns, mild to moderated asphyxia and severe asphyxia were presenting 32 (69.6%) and 14 (30.4%) cases respectively. HIE-I were 20 (43.5%), HIE II-16 (34.8%) and HIE III-10 (21.7%). The mean serum magnesium level in neonates with mild to moderate asphyxia was 2.1±0.3 and with severe asphyxia 1.5±0.5 respectively (p=0.001). Serum magnesium was significantly low in severe birth asphyxia as compared to mild to moderate (p=0.001) and level was significantly low in HIE stage 3. The difference in serum magnesium between HIE 1 and 3 and HIE 2 and HIE 3 was statistically significant (p=0.003 and p=0.009, respectively). A significant correlation between serum magnesium and Apgar score at 1 minute (Pearson's correlation coefficient, r=0.518, p=0.001) and score at 5 minutes was also statistically significant (Pearson's correlation coefficient, r=0.379, p=0.009). Conclusions: Neonates with severe asphyxia and HIE-grade III have significant hypomagnesemia. Asphyxia can lead to hypomagnesemia, and it is recommended to evaluate levels of magnesium in neonates with asphyxia as a routine test.
Cureus, 2021
Background In Pakistan, the neonatal mortality rate is 41 per 1,000 live births and birth asphyxia is one of the leading causes of neonatal mortality and morbidity. The goal of this study was to determine whether postnatal magnesium sulfate therapy can improve short- and long-term neurological outcomes in term or near-term neonates with moderate-to-severe birth asphyxia. Methodology This prospective double-blind randomized controlled trial was conducted in the Neonatology Department of the Children’s Hospital & The Institute of Child Health, Lahore. A total of 62 neonates (31 in each group) were randomized to receive either three doses of magnesium sulfate infusion at 250 mg/kg per dose, 24 hours apart (treatment group), or three doses of injection 10% distilled water infusion at 3 mL/kg, 24 hours apart (placebo group). Both groups received similar supportive care. The neurodevelopmental assessment was done at six months of age using the ShaMaq Developmental Inventory. Results Demog...
Magnesium sulfate effect on erythrocyte membranes of asphyxiated newborns
Clinical Biochemistry, 2005
Objectives: Magnesium sulfate has been recognized as a neuroprotective agent against hypoxia-ischemia, mainly by the protection from the excitotoxicity associated with increased glutamate concentration. However, the mechanism of MgSO 4 action is not fully understood and is considerably controversial.
Developmental neuroscience, 2018
Magnesium is an intracellular cation essential for many en-zymatic processes and cellular functions. Magnesium sulfate acts as an endogenous calcium channel antagonist at neuronal synapses, thought to prevent excessive activation of N-methyl-D-aspartate receptors by excitatory amino acids, such as glutamate, and by downregulation of proinflammatory pathways. Early intervention is essential in the prevention of the secondary phase of neuronal injury. The immature brain is particularly prone to excitotoxicity, and inflammation has been strongly implicated in the pathogenesis of cerebral palsy. This article explores the current status of magnesium being used as an adjunct to hypothermia in term neonatal encephalopathy (NE) against a background of its use in other populations. There is some evidence for magnesium sulfate as a neuroprotective agent, however animal studies of NE at term equivalent age have been confounded by concomitant hypothermia induced by magnesium itself. Nevertheles...
Scholars Journal of Applied Medical Sciences, 2020
Original Research Article Objective: To determine effectiveness of Magnesium Sulphate infusion in full term neonate suffering from moderate and severe perinatal asphyxia. Methods: Full term neonates with perinatal asphyxia were selected and classified according to criteria laid by Sarnat and Sarnat. After recording baseline characteristics they were randomly assigned to receive either 3 doses of magnesium sulfate infusion at 250 mg/kg/dose 24 hours apart (treatment group) or 3 doses of normal saline infusion at 1 ml/kg/dose 24 hours apart (placebo group). Neurological assessment was performed at time of admission and at fourteenth day. Distributions of perinatal factors, neonatal baseline characteristics, and mean time for initial infusions were noted in pre designed proforma and analyzed statistically. Results: Distribution of neonatal baseline characteristics and severity of hypoxic-ischemic encephalopathy were similar in treatment and placebo groups. In our study, postnatal magnesium sulfate infusion was found neuroprotective in moderate encephalopathy, which was reflected by early control of seizures (p=0.04), early appearance of normal cry (p=0.02), early appearance of normal activity (p=0.02), early acceptance of full oral feed by sucking (p=0.04). Postnatal magnesium sulfate infusion was not found neuroprotective in severe encephalopathy (p=>0.05). No significant differences were observed in the cranial sonography and electroencephalography between treated and placebo groups (p=>0.05). No significant differences were observed in blood pressure, heart rate and respiratory rate between both the groups. Conclusion: Postnatal magnesium sulfate therapy may result in early recovery and favorable neurological outcome in term neonates with moderate encephalopathy.
Magnesium for newborns with hypoxic-ischemic encephalopathy: a systematic review and meta-analysis
Journal of Perinatology, 2013
Magnesium may have a role in neuroprotection in neonatal hypoxic-ischemic encephalopathy (HIE). The objective of this study was to systematically review the efficacy and safety of postnatal magnesium therapy in newborns with HIE. STUDY DESIGN: MEDLINE, EMBASE, CINAHL and CCRCT were searched for studies of magnesium for HIE. Randomized controlled trials that compared magnesium to control in newborns with HIE were selected. The primary outcome was a composite outcome of death or moderate-to-severe neurodevelopmental disability at 18 months. When appropriate, meta-analyses were conducted using random effects model and risk ratios (RRs) and 95% confidence intervals (CIs) were calculated. RESULT: Five studies with sufficient quality were included. There was no difference in the primary outcome between the magnesium and the control groups (RR 0.81, 95% CI 0.36 to 1.84). There was significant reduction in the unfavorable short-term composite outcome (RR 0.48, 95% CI 0.30 to 0.77) but no difference in mortality (RR 1.39, 95% CI 0.85 to 2.27), seizures (RR 0.84, 95% CI 0.59 to 1.19) or hypotension (RR 1.28, 95% CI 0.69 to 2.38) between the magnesium and the control groups. CONCLUSION: The improvement in short-term outcomes without significant increase in side effects indicate the need for further trials to determine if there are long-term benefits of magnesium and to confirm its safety. Mortality was statistically insignificant between the magnesium and the control groups. However, the trend toward increase in mortality in the magnesium group is a major clinical concern and should be monitored closely in future trials.
Magnesium Sulphate Treated Severely Asphyxiated Neonates, Their Characteristic and Outcome
Asian Journal of Pediatric Research
Introduction: Perinatal asphyxia is a common neonatal problem and contributes significantly to neonatal morbidity and mortality. Encephalopathy occurs in 50% to 60% of patients with severe perinatal asphyxia. Moderate hypoxic ischaemic encephalopathy (HIE), 10% to 20% die and 30% to 40% develop neurodeficits, whereas 50% of those with severe HIE die and almost all survivors develop neurodeficits. The systematic administration of magnesium sulphate (MgSO4) after perinatal asphyxia has shown effective resolution of neuronal injury. We have conducted this study to validate the effect of MgSO4 in severely asphyxiated neonates, so as to utilize its benefits on ameliorating the outcome associated with severe perinatal asphyxia/HIE. Objective of the Study: To determine the characteristics and outcome of magnesium sulphate on neurological outcome in severe perinatal asphyxia Materials and Methods: A prospective interventional study of magnesium sulphate treatment of neonates with severe pe...