Abstract
BackgroundMagnesium sulphate (MgSO4) is the only treatment approved for fetal neuroprotection. No information on its use is available in the absence of a national registry of neonatal practices. The objective of our study was to evaluate the use of MgSO4 for fetal neuroprotection in French tertiary maternity hospitals (FTMH).MethodsOnline and phone survey of all FTMH between August 2014 and May 2015. A participation was expected from one senior obstetrician, one senior anaesthetist and one senior neonatologist from each FTMH. Information was obtained from 63/63 (100%) FTMH and 138/189 (73%) physicians. Use of MgSO4 for fetal neuroprotection, regimen and injection protocols, reasons for non-use were the main outcome measures.Results60.3% of FTMH used MgSO4 for fetal neuroprotection. No significant difference was observed between university and non-university hospitals or according to the annual number of births. Protocols differed especially in terms of the maximum gestational age (3% <28 WG, 71% <33 WG, 18% <34 WG and 8% < 35 WG). Eighty seven percent of centers using MgSO4 prescribed retreatment when necessary, but according to non-consensual modalities in terms of number of treatments or between-treatment intervals. Injections and monitoring were mostly performed in the delivery room (97%) but also in the recovery room in one half of hospitals. Lack of experience (52%), absence of a written protocol (49%) and national guidelines (46%) were the reasons most commonly reported to explain non-use of MgSO4 as a neuroprotective agent.ConclusionsSixty percent of FTMH used MgSO4 for fetal neuroprotection, but according to heterogeneous regimens. National guidelines could allow standardization of practices and better MgSO4 coverage.
Highlights
Magnesium sulphate (MgSO4) is the only treatment approved for fetal neuroprotection
Study design This study was designed to evaluate the use of MgSO4 prior to preterm birth in all French tertiary maternity hospitals (FTMH) to describe the various protocols used and to analyze the reasons for non-use
Main findings This study provides an update on the reported use of MgSO4 for fetal neuroprotection in France, in the absence of a national registry of neonatal practices in France
Summary
No information on its use is available in the absence of a national registry of neonatal practices. In the light of these convincing results, several national authorities (USA, Australia and New Zealand, Canada, UK, Belgium and Ireland) have recommended antenatal administration of MgSO4 in women at imminent risk of very preterm birth in order to prevent cerebral palsy [18,19,20,21,22,23,24]. No information on the use of MgSO4 in France is available in the absence of a national registry of neonatal practices
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