Immediate clinical outcomes in preterm neonates receiving antenatal magnesium for neuroprotection

Sudeepta Kumar Basu; Vijay Chickajajur; Vivian Lopez; Alok Bhutada; Murali Pagala; Shantanu Rastogi

doi:10.1515/jpm.2011.094

Article

Immediate clinical outcomes in preterm neonates receiving antenatal magnesium for neuroprotection

Sudeepta Kumar Basu , Vijay Chickajajur , Vivian Lopez , Alok Bhutada , Murali Pagala and Shantanu Rastogi

Published/Copyright: August 11, 2011

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From the journal Volume 40 Issue 2

Abstract

Background: Antenatal magnesium sulfate can potentially reduce the risk of cerebral palsy in neonates delivered between 24 and 32 weeks of gestational age. Some studies using high-dose magnesium sulfate for neuroprotection have reported increased perinatal mortality.

Methods: A retrospective study was conducted on 475 neonates born between 24 and 32 weeks of gestational age. Serum magnesium level in the first 24 h of life was used to stratify the neonates treated with antenatal magnesium into four subgroups: A (<2.5 mEq/L), B (≥2.5 to <3.5 mEq/L), C (≥3.5 to <4.5 mEq/L), and D (≥4.5 mEq/L). Primary outcome of survival without intraventricular hemorrhage (IVH) and/or periventricular leukomalacia (PVL) along with secondary outcomes, such as Apgar scores, resuscitation, intubation, broncho-pulmonary dysplasia, retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), time to reach full feeds, length of stay (LOS), and mortality during immediate neonatal period were studied.

Results: Of the 475 neonates included in the study, 289 (61%) received antenatal magnesium sulfate. Primary outcome of survival without IVH and/or PVL among the preterm neonates was 70.9% in those receiving and 74.2% in those not receiving antenatal magnesium (P=0.25). There were higher incidences of ROP (P=0.02), PDA (P=0.01), greater time to reach full feeds (P=0.03), and increased LOS (P=0.01) in neonates who had received antenatal magnesium. These findings were not statistically significant when the data were corrected for gestational age and birth weight. Among the subgroups, there was a significantly increased mortality rate (P<0.05) with increasing magnesium levels (5% vs. 16.9%, P<0.05 in groups A vs. D) and a trend toward higher intubation rate (P=0.1) and PDA (P=0.14).

Conclusion: Antenatal magnesium is safe in the immediate postnatal period; however, in the subset of preterm neonates with serum magnesium levels >4.5 mEq/L, there is increased mortality independent of birth weight and gestational age. Identification of these neonates and appropriate dosing for their antenatal neuroprotection needs to be studied.

Keywords: Magnesium; mortality; neuroprotection; outcomes; preterm neonates

Corresponding author: Shantanu Rastogi, MD, MMM Associate Professor of Clinical Pediatrics SUNY-HSC at Brooklyn Attending Neonatologist Maimonides Infants and Children Hospital 1048 Tenth Avenue G-103 Brooklyn NY 11203 USA Tel.: +1-718-283-8853

Received: 2011-6-28

Accepted: 2011-6-30

Published Online: 2011-08-11

Published in Print: 2012-02-01

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https://doi.org/10.1515/jpm.2011.094

Keywords for this article

Magnesium; mortality; neuroprotection; outcomes; preterm neonates