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.
1
The results of these trials found no differences in the rate of the primary outcome
(death/CP) with the use of Mag,
2
but secondary analysis of outcomes in 3 trials found a significant reduction in the
rate of neonatal CP among those exposed to Mag.
3
,
4
,
5
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.
6
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References
- Magnesium sulfate for women at risk of preterm birth for neuroprotection of the fetus.Cochrane Database Syst Rev. 2009; 3: 1-93
- Committee opinion no. 455: magnesium sulfate before anticipated preterm birth for neuroprotection.Obstet Gynecol. 2010; 115: 669-671
- Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial; Australasian collaborative trial of magnesium sulphate (ACTOMg SO4) collaborative group.JAMA. 2008; 290: 2669-2676
- Magnesium sulphate given before very very-preterm birth to protect infant brain: the randomized controlled PREMAG trial.BJOG. 2007; 114: 310-318
- A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy; Eunice Kennedy Shriver NICHD Maternal-Fetal Units Network.N Engl J Med. 2008; 359: 895-905
- Antenatal magnesium sulfate may prevent cerebral palsy in preterm infants–but are we convinced?.BJOG. 2011; 118: 1-5
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© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
