Effects of antenatal exposure to magnesium sulfate on neuroprotection and mortality in preterm infants: a meta-analysis.

نویسندگان

  • Maged M Costantine
  • Steven J Weiner
چکیده

OBJECTIVE To review the evidence regarding neuroprotective effects of antenatal exposure to magnesium sulfate. DATA SOURCES We conducted database searches of MEDLINE, the Cochrane Library and Controlled Trials Register, as well as the ClinicalTrials.gov and International Clinical Trials Register websites. Bibliographies of all relevant articles were reviewed. METHODS OF STUDY SELECTION Randomized controlled trials comparing magnesium sulfate with placebo/other treatment in patients at risk of preterm delivery were evaluated for inclusion and methodological quality. The primary outcome was death or cerebral palsy by 18-24 months corrected age. Secondary outcomes were death, cerebral palsy, moderate-severe cerebral palsy, and death or moderate-severe cerebral palsy. Separate analyses were performed according to the gestational age (GA) at randomization (less than 32 to 34 weeks and less than 30 weeks) and for studies in which magnesium sulfate was used exclusively for fetal neuroprotection. TABULATION, INTEGRATION, AND RESULTS Five randomized controlled trials were included (5,235 fetuses/infants). When analyzed by GA at randomization, in utero exposure to magnesium sulfate at less than 32-34 weeks did not reduce the rate of death or cerebral palsy (relative risk [RR] 0.92, 95% confidence interval [CI] 0.83-1.03). However, cerebral palsy (RR 0.70, 95% CI 0.55-0.89), moderate-severe cerebral palsy (RR 0.60, 95% CI 0.43-0.84), and death or moderate-severe cerebral palsy were significantly reduced, without an evident increase in the risk of death (RR 1.01, 95% CI 0.89-1.14). Similar results were obtained when the GA at randomization was less than 30 weeks. When only neuroprotection trials (four trials, 4,324 fetuses/infants) are analyzed, in utero exposure to magnesium sulfate additionally reduced the primary outcome of death or cerebral palsy. The number needed to treat to prevent one case of cerebral palsy among those who survive until age 18-24 months is 46 (95% CI 26-187) in infants exposed to magnesium sulfate in utero before 30 weeks, and 56 (95% CI 34-164) in infants exposed to magnesium sulfate in utero before 32 to 34 weeks. CONCLUSION Fetal exposure to magnesium sulfate in women at risk of preterm delivery significantly reduces the risk of cerebral palsy without increasing the risk of death.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

The use of antenatal magnesium sulfate for neuroprotection for infants born prematurely

Cerebral palsy occurs in three to four infants per 1000 live births. Preterm birth prior to 34 weeks' gestation is a major risk factor. Five randomized controlled trials of antenatal magnesium sulfate (MgSO(4)) found a trend of reduced risk of cerebral palsy and mortality in preterm infants. Three meta-analyses using the data from the five randomized controlled trials, which included a total of...

متن کامل

Effects and Safety of Magnesium Sulfate on Neuroprotection

To evaluate the evidence of effects and safety of magnesium sulfate on neuroprotection for preterm infants who had exposure in uteri. We searched electronic databases and bibliographies of relevant papers to identify studies comparing magnesium sulfate (MgSO4) with placebo or other treatments in patients at high risk of preterm labor and reporting effects and safety of MgSO4 for antenatal infan...

متن کامل

Antenatal magnesium sulfate for neuroprotection before preterm birth?

Preterm infants are at increased risk for serious, lifelong neurologic abnormalities such as cerebral palsy.1,2 As the survival of preterm infants has improved with advances in perinatal care,2 the occurrence of cerebral palsy has increased further, since infants who would previously have died now survive with their cerebral pathology. Currently, more than 30% of children with cerebral palsy ar...

متن کامل

Postnatal Preventive Effect of Magnesium Sulfate on Intraventricular Hemorrhage of Preterm Infants

Background: Germinal matrix hemorrhage and intraventricular hemorrhage (GMH-IVH) are among the causes of morbidity and mortality in very low birth weight (VLBW) neonates. The aim of this study was to determine the postnatal prophylactic effect of magnesium sulfate on GMH-IVH.Methods: In this double-blind clinical trial, 140 VLBW newborns were selected. The babies with birth weight ≤ 1500 ...

متن کامل

Antenatal Dexamethasone For Women at Risk af Preterm Birth and Intraventricular Haemorrhage: What is the Truth?

Administration of antenatal corticosteroids to pregnant women with imminent delivery of a newborn at 24 to 34 weeks of gestation represents one of the most important advances in perinatal medicine in the past 25 years1,2. A single course of antenatal steroid has been associated with a decrease in acute neonatal systemic morbidity and mortality after preterm birth reducing the risk of respirator...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Obstetrics and gynecology

دوره 114 2 Pt 1  شماره 

صفحات  -

تاریخ انتشار 2009