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Magnesium sulfate for neuroprotection in patients at risk for early preterm delivery: not yet

      Infants born at <34 weeks are at increased risk for cerebral palsy (CP). This risk increases inversely according to gestational age at delivery: approximately 10% at <28 weeks, 6% at 28-29 weeks, and 1.4% at 30-33 weeks. Several retrospective studies evaluated the association between magnesium sulfate (Mag) exposure and the risks of neonatal germinal matrix hemorrhage and CP; some found a beneficial effect whereas others did not. Recently, 4 randomized placebo-controlled trials investigated the benefits of Mag for neuroprotection in women at risk for early preterm delivery.
      • Doyle L.W.
      • Crowther C.A.
      • Middleton P.
      • et al.
      Magnesium sulfate for women at risk of preterm birth for neuroprotection of the fetus.
      The results of these trials found no differences in the rate of the primary outcome (death/CP) with the use of Mag,
      American College of Obstetricians and GynecologistsACOG Committee on Obstetric PracticeSociety for Maternal-Fetal Medicine
      Committee opinion no. 455: magnesium sulfate before anticipated preterm birth for neuroprotection.
      but secondary analysis of outcomes in 3 trials found a significant reduction in the rate of neonatal CP among those exposed to Mag.
      • Crowther C.A.
      • Hiller J.E.
      • Doyle L.W.
      • Haslam R.R.
      Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial; Australasian collaborative trial of magnesium sulphate (ACTOMg SO4) collaborative group.
      • Marret S.
      • Marpeau I.
      • Zupan-Simunek V.
      • et al.
      Magnesium sulphate given before very very-preterm birth to protect infant brain: the randomized controlled PREMAG trial.
      • Rouse D.J.
      • Hirtz D.G.
      • Thom E.
      • et al.
      A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy; Eunice Kennedy Shriver NICHD Maternal-Fetal Units Network.
      These trials were the subject of several recent metaanalyses and expert opinions with recommendations that have created some uncertainty about whether to offer Mag for neuroprotection and, if offered, about the dose to be used, and the proper gestational age.
      • Huusom L.D.
      • Secher N.J.
      • Pryds O.
      • et al.
      Antenatal magnesium sulfate may prevent cerebral palsy in preterm infants–but are we convinced? Evaluation of an apparently conclusive meta-analysis with trial sequential analysis.
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      References

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        • Crowther C.A.
        • Middleton P.
        • et al.
        Magnesium sulfate for women at risk of preterm birth for neuroprotection of the fetus.
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        Antenatal magnesium sulfate may prevent cerebral palsy in preterm infants–but are we convinced?.
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