Association between maternal serum ionized magnesium levels at delivery and neonatal intraventricular hemorrhage

Abstract

Objectives: To determine whether magnesium sulfate (MgSO4) exposure is associated with a reduced risk for neonatal intraventricular hemorrhage (IVH). Study design: In a randomized, controlled trial, women in preterm labor were randomly assigned to receive MgSO4, “other” tocolytic, or saline control. At delivery, we collected maternal antecubital and umbilical cord blood for determination of serum ionized magnesium levels. Neonatal IVH was diagnosed by cranial ultrasonogram. Results: Among 144 infants, 24 were diagnosed with IVH. Using crude intention-to-treat analysis, we found that 18% (13/74) of survivors exposed after birth to MgSO4 had IVH compared with 16% (11/70) of babies who were not exposed. Infants who had IVH were more likely to have been delivered by mothers with higher serum ionized magnesium (Mg) levels (0.75 vs 0.56 mmol/L) (P =.01). Using multivariable logistic regression, we confirmed that higher Mg levels are a significant predictor of neonatal IVH (adjusted odds ratio, 15.8; 95% CI, 1.4-175.0) even when adjusted for birth weight, gestational age, antenatal hemorrhage, and neonatal glucocorticoid exposure. Conclusions: In mothers with preterm labor, our data indicate that antenatal MgSO4 exposure may be associated with an increased risk for IVH among their newborns. (J Pediatr 2002;140:540-6)