MgSO4 and Neuroprotection: What is the Relationship Between Maternal Dose and Fetal Levels?
BACKGROUND AND PURPOSE:
A Cochrane review established that antenatal magnesium sulfate (MgSO4) reduces cerebral palsy and severe motor dysfunction at 2 years of age in infants delivered <32 weeks
Alonso et al. (American Journal of Perinatology, 2018) sought to determine the relationship between the magnesium dose delivered to the mother, subsequent magnesium concentration in neonates and related newborn outcomes
Prospective cohort study
Participants: Infants delivered < 32 weeks who were admitted to the NICU
Neonates were categorized into
Those exposed to MgSO4
MgSO4 levels were measured in neonates
The MgSO4 protocol in the research center was as follows
4 g loading dose over a half-hour period
1 g/h perfusion until delivery
MgSO4 suspended if delivery did not take place within 24 hours of having commenced the perfusion
If an imminent risk of preterm delivery re-emerged treatment resumed
If >6 hours have passed since the perfusion was suspended, the maintenance dose was continued, otherwise repeat bolus was administered
Comparative analysis of magnesium levels between groups
Advanced neonatal resuscitation in the delivery | Apgar scores | Invasive mechanical ventilation | IVH and/or PVL | Bronchopulmonary dysplasia Retinopathy of prematurity | Patent ductus arteriosus | Mortality
A total of 118 neonates were included in the study
62 mothers received MgSO4 as a neuroprotective agent
There was a significant correlation between the full dose of MgSO4 received by the mother and the levels of magnesium in the neonate in the first 24 hours of life (p < 0.001)
When taking in to account gestational age and birth weight
Incidences of newborn complications, including neonatal resuscitation, surfactant doses, retinopathy of prematurity, and bronchopulmonary dysplasia were not statistically significant
MgSO4 subgroup analysis trends
Intensive cardiopulmonary resuscitation, bronchopulmonary dysplasia, surfactant requirement, and retinopathy of prematurity showed trends with increasing magnesium levels but did not reach statistical significance
Mean levels of magnesium in the infants were 2.68 mg/dL, which is below 4.5 mg/dL side effect threshold, which is associated with increased mortality risk in newborns
Maximum serum magnesium concentration in a newborn was 4.04 mg/dL, which corresponds to 20 g of MgSO4 received by the mother
Authors suggest 20 g administered over 16 hours continuous perfusion to be the upper limit of a safe dose based on the results in this paper
The MgSO4 dose received by the mother has a linear relationship with the magnesium levels obtained in neonates
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