Intérêt du sulfate de magnésium dans la prévention de la paralysie cérébrale de l’enfant né prématuré

Abstract

This review concentrates on best evidence emerging in recent years on cerebral palsy prevention by administration of magnesium sulphate in mothers being at risk of preterm birth before 33–34 weeks’ gestation. It has been shown in the Cochrane database and in three meta-analysis of five randomised trials (Magpie Trial [neuroprotection of the preeclamptic mother], MagNet [neuroprotection/other intent: tocolysis], ACTOMgSO4 [neuroprotection], PRE-MAG [neuroprotection] and BEAM [neuroprotection]) that prenatal low-dose of magnesium sulphate given to mothers at risk of preterm birth has no severe deleterious effects in mothers and does not increase paediatric mortality in verypreterm infants. Moreover, it has a significant neuroprotective effects on occurrence of cerebral palsy at two years of age (with a 0.69 relative risk and a 95% confidence interval 0.54–0.87) and, in the neuroprotection subgroup, on the combined outcome of pediatric mortality or cerebral palsy (with a 0.85 relative risk and a 95% confidence interval: 0.74–0.98). The number needed to treat (NNT) to prevent one case of cerebral palsy was 63 (95% CI: 39 to 172) and the NNT for an extra survivor free of cerebral palsy in the neuroprotection subgroup was 41 (95% CI: 22 to 357), justifying that magnesium sulphate should be discussed as a stand-alone treatment or as part of a combination treatment.