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Using prophylactic, but not tocolytic, magnesium sulfate to reduce cerebral palsy related to prematurity: what dose, and what about infant mortality?
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Peter G. Pryde
Veröffentlicht/Copyright:
14. April 2011
Abstract
Strategies for the prevention of cerebral palsy (CP) remain incompletely characterized. Recognizing that half of all cases are associated with preterm delivery (Australian CP Register Report, 2009), research protocols aimed at reducing its prevalence have focused on interventions in pregnancies at risk for preterm birth. Compelling data from recent clinical trials have led to an emerging consensus favoring the use of antenatal magnesium sulfate for preterm neuroprophylaxis. Unresolved, however, is the critical question regarding the “best dose”. Acknowledging that any substance in high enough doses becomes toxic, the “best dose” is really the least dose that achieves efficacy, while minimizing potential toxicity among susceptible fetuses. Importantly, credible evidence from these CP prevention trials indicates that antenatal magnesium sulfate, if dosed appropriately, may also decrease infant mortality – a worthy goal in its own right. Accordingly, whether we achieve (a) reduction in CP only, (b) simultaneous reduction in CP and infant mortality, or (c) CP reduction offset by possibly increased pediatric mortality, may depend on selection of dose. In this Opinion paper, we review the findings of all major randomized trials that tested the magnesium hypothesis for prevention of CP. In addition, we discuss future research, in progress, that is hoped to refine estimates of best dose.
Keywords: Best dose of magnesium; magnesium sulfate neuroprophylaxis; prevention of cerebral palsy; prevention of infant mortality
Received: 2010-12-8
Revised: 2011-3-3
Accepted: 2011-3-4
Published Online: 2011-04-14
Published Online: 2011-04-14
Published in Print: 2011-07-01
©2011 by Walter de Gruyter Berlin Boston
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- Original articles – Newborn
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- Stability of thyroid hormones during continuous infusion
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- Congress calendar
- Congress Calendar
Schlagwörter für diesen Artikel
Best dose of magnesium;
magnesium sulfate neuroprophylaxis;
prevention of cerebral palsy;
prevention of infant mortality
Artikel in diesem Heft
- Review articles
- Bridging global gene expression candidates in first trimester placentas with susceptibility loci from linkage studies of preeclampsia
- Candidates for the determination of antithrombin activity in pregnant women
- Opinion paper
- Using prophylactic, but not tocolytic, magnesium sulfate to reduce cerebral palsy related to prematurity: what dose, and what about infant mortality?
- Original articles – Obstetrics
- Vaginal breech delivery in very low birth weight (VLBW) neonates: experience of a single center
- Fetal outcome for infants in breech by method of delivery: experiences with a stand-by service system of senior obstetricians and women's choices of mode of delivery
- Characterization of discriminatory urinary proteomic biomarkers for severe preeclampsia using SELDI-TOF mass spectrometry
- Oxytocin versus dinoprostone vaginal insert for induction of labor after previous cesarean section: a retrospective comparative study
- Mid-trimester amniotic fluid concentrations of the proinflammatory cytokines IL-6, IL-8, TNF-α, and lipopolysaccharide binding protein in normal pregnancies: a prospective evaluation according to parity, gestational age, and fetal gender
- Expression of laminin receptor 1 in human placentas from normal and preeclamptic pregnancies and its relationship with the severity of preeclampsia
- Colonization, serotypes and transmission rates of group B streptococci in pregnant women and their infants born at a single University Center in Germany
- The placental factor in spontaneous preterm labor with and without premature rupture of membranes
- A 29-gauge atraumatic needle for amniocentesis
- Gestational diabetes mellitus complicating twin pregnancies
- Original articles – Fetus
- Results of and further prevention of hypoxic fetal brain damage by inhibition of xanthine oxidase enzyme with allopurinol
- Diastolic forward flow in the fetal main pulmonary artery and its implication for fetal cardiac cycle evaluation
- Abnormalities of the penis in utero – hypospadias on fetal MRI
- Intrapartum cardiotocography (CTG) and ST-analysis of labor in diabetic patients
- Original articles – Newborn
- Ductus venosus flow at 11–13 weeks in the prediction of birth weight discordance in monochorionic twins
- Stability of thyroid hormones during continuous infusion
- Short communication
- Supracervical cerclage with intracavitary balloon to control bleeding associated with placenta previa
- Letter to the Editor
- Two cases of Lowe syndrome presenting as increased fetal nuchal translucency
- Congress calendar
- Congress Calendar
