Antenatal Magnesium Sulfate Exposure Research Articles

Efficacy of antenatal magnesium sulfate in the prevention of necrotizing enterocolitis: A randomized case-control study in preterm neonates.

Objective: To assess the efficacy of administering antenatal magnesium sulfate in reducing the occurrence of necrotizing enterocolitis in preterm infants. Study Design: Randomized Case-control study. Setting: Hameed Latif Hospital Lahore. Period: August 2023- February 2024. Methods: The study including 80 preterm neonates (26 to 32 weeks gestation) was conducted at Neonatology & Gynaecology Unit Hameed Latif Hospital, Lahore. These neonates were divided into two groups: Group A included infants whose mothers were given magnesium sulfate before preterm birth, while Group B comprised of infants whose mothers did not receive magnesium sulfate. The primary outcome was the incidence of NEC in infants born to mothers exposed to magnesium sulfate, with secondary outcomes covering other neonatal morbidities and maternal side effects. Data analysis utilized SPSS Statistics software version 24, employing t-tests and multivariate logistic regression to evaluate the association between antenatal magnesium sulfate exposure and NEC incidence, considering a significant p-value of ≤ 0.05. Results: The overall NEC incidence was 5%(n=2). No NEC cases were reported in the control group. The difference in neonatal outcomes between both groups was statistically insignificant (p>0.05). Conclusion: Administering antenatal magnesium sulfate has no effect in decreasing the incidence of NEC in preterm infants.

Retraction and republication - effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The MagNUM Study.

On August 25, 2020, eBioMedicine published online findings from a nested cohort study within the randomised Magnesium sulphate at 30 to <34 weeks’ Gestational age Neuroprotection Trial (MAGENTA). On November 17, 2021, the authors drew our attention to an error that was discovered when the dataset for the parent randomised trial was being finalised. The original MagNUM analysis was conducted blind to treatment group allocation, and an incorrect code was used at the end of that analysis to identify the magnesium sulphate and placebo study groups. Therefore, the group allocations to the magnesium sulphate and placebo study groups in the paper were inadvertently reversed, making the findings, as reported, unreliable. eBioMedicine editors discussed the corrections that were needed in the paper and decided, in accordance with the Committee on Publication Ethics’ guidelines, that because of the extent of the changes necessary, the previous version of the Article should be retracted. As these data are still worthy of publication, a corrected version will be republished after reanalysis and rereview. Today we retract the previous version and republish online the corrected version of the article DOI: 10.1016/j.ebiom.2022.103923 in which the results are unchanged apart from the treatment group assignment. The figures and tables have been corrected accordingly, and the overall message has been modified to convey that antenatal magnesium sulphate prior to preterm birth after 30 weeks’ gestation does not promote white matter development in pathways affecting motor and cognitive function. The previous version of the Article has been added to the appendix in the new version and is marked retracted. The Editors of eBioMedicine. None. RETRACTED: Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The magnum studyThis article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). Full-Text PDF Open AccessEffect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The MagNUM StudyIn babies born preterm after 30 weeks’ gestation, antenatal magnesium sulphate exposure did not promote development of white matter microstructure in pathways affecting motor or cognitive function. This suggests that if the neuroprotective effect of magnesium sulphate treatment prior to preterm birth is confirmed at this gestation, the mechanisms are not related to accelerated white matter maturation inferred from fractional anisotropy. Full-Text PDF Open Access

Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The MagNUM Study.

SummaryBackgroundMagnesium sulphate given to women prior to very preterm birth protects the perinatal brain, so fewer babies die or develop cerebral palsy. How magnesium sulphate exerts these beneficial effects remains uncertain. The MagNUM Study aimed to assess the effect of exposure to antenatal magnesium sulphate on MRI measures of brain white matter microstructure at term equivalent age.MethodsNested cohort study within the Magnesium sulphate at 30 to <34 weeks’ Gestational age Neuroprotection Trial (MAGENTA). Australian New Zealand Clinical Trials Registry ACTRN12611000491965. Mothers at risk of preterm birth at 30 to <34 weeks’ gestation were randomised to receive either 4 g of magnesium sulphate heptahydrate [8 mmol magnesium ions], or saline placebo, when preterm birth was planned or expected within 24 h. Participating babies underwent diffusion tensor MRI at term equivalent age. The main outcomes were fractional anisotropy across the white matter tract skeleton compared using Tract-based Spatial Statistics (TBSS), with adjustment for postmenstrual age at birth and at MRI, and MRI site. Researchers and families were blind to treatment group allocation during data collection and analyses.FindingsOf the 109 babies the demographics of the 49 babies exposed to magnesium sulphate were similar to the 60 babies exposed to placebo. In babies whose mothers were allocated to magnesium sulphate, fractional anisotropy was lower within the corticospinal tracts and corona radiata, the superior and inferior longitudinal fasciculi, and the inferior fronto-occipital fasciculi compared to babies whose mothers were allocated placebo (P < 0·05).InterpretationIn babies born preterm after 30 weeks’ gestation, antenatal magnesium sulphate exposure did not promote development of white matter microstructure in pathways affecting motor or cognitive function. This suggests that if the neuroprotective effect of magnesium sulphate treatment prior to preterm birth is confirmed at this gestation, the mechanisms are not related to accelerated white matter maturation inferred from fractional anisotropy.FundingThis study was funded by a project grant from the Health Research Council of New Zealand (HRC 14/153).

Changing Tocolytic Exposures among Neonatal Intensive Care Unit Admitted Preterm Infants.

Since 2010, the American College of Obstetrics and Gynecology have released three committee opinions to recommend and reaffirm the utility of magnesium sulfate for neuroprotection and later for tocolysis to achieve antenatal steroid course completion in preterm labor. We sought to determine changes in antenatal magnesium sulfate exposure and other tocolytic agents for pregnancies resulting in neonatal intensive care unit (NICU)-admitted preterm infants. Using the Pediatrix Clinical Data Warehouse, we evaluated all inborn infants delivered between 22 and 33 weeks' gestation and admitted to the intensive care units from 2009 to 2018. We classified patients based on antenatal exposure to tocolytic medications: calcium channel blockers (nifedipine and amlodipine), betamimetics (terbutaline, theophylline, and ritodrine), prostaglandin inhibitors (indomethacin), and magnesium sulfate. A total of 229,781 patients met inclusion criteria. During the study period, magnesium sulfate exposure increased from 27.6 to 57.7% of births while betamimetic exposure decreased from 10.2 to 5.2%. Increasing magnesium sulfate exposure over time was seen at all gestational ages examined and magnesium exposure was most common between 23 and 31 weeks' gestation. By 2017 to 2018, 70.5% of 24 to 29 weeks' gestation NICU infants received exposure to at least one tocolytic agent while this remained at 53.7% of 32 to 33 weeks' NICU admitted infants. Antenatal steroid exposure increased from 74.8 to 87.4% during the study period. For NICU-admitted preterm infants, prenatal exposure patterns to tocolytic agents has shifted since 2009 with prenatal magnesium sulfate exposure increasing significantly. Antenatal steroid exposure has risen concurrently. Exposure to tocolytic agents is the highest among preterm infants born between 24 and 29 weeks' gestation. · Exposure to magnesium sulfate significantly increased from 2009 to 2018 for NICU admitted infants.. · Concurrently, the use of other tocolytics decreased significantly.. · The use of antenatal steroids has been rising over time..

Effect of antenatal magnesium sulphate on MRI biomarkers of white matter development at term equivalent age: The magnum study.

BackgroundMagnesium sulphate given to women immediately prior to very preterm birth protects the perinatal brain, so fewer babies die or develop cerebral palsy. How magnesium sulphate exerts these beneficial effects remains uncertain. The aim of the MagNUM Study was to assess the effect of exposure to antenatal magnesium sulphate on MRI measures of brain white matter microstructure at term equivalent age.MethodsNested cohort study within the randomised Magnesium sulphate at 30 to <34 weeks’ Gestational age Neuroprotection Trial (MAGENTA). Mothers at risk of preterm birth at 30 to <34 weeks’ gestation were randomised to receive either 4 g of magnesium sulphate heptahydrate [8 mmol magnesium ions], or saline placebo, infused over 30 min when preterm birth was planned or expected within 24 h. Participating babies underwent diffusion tensor MRI at term equivalent age. The main outcomes were fractional anisotropy across the white matter tract skeleton compared using Tract-based Spatial Statistics (TBSS), with adjustment for postmenstrual age at birth and at MRI, and MRI site. Researchers and families were blind to treatment group allocation during data collection and analyses.FindingsOf the 109 participating babies the demographics of the 60 babies exposed to magnesium sulphate were similar to the 49 babies exposed to placebo. In babies whose mothers were allocated to magnesium sulphate, fractional anisotropy was higher within the corticospinal tracts and corona radiata, the superior and inferior longitudinal fasciculi, and the inferior fronto-occipital fasciculi compared to babies whose mothers were allocated placebo (P < 0.05).InterpretationIn babies born preterm, antenatal magnesium sulphate exposure promotes development of white matter microstructure in pathways affecting both motor and cognitive function. This may be one mechanism for the neuroprotective effect of magnesium sulphate treatment prior to preterm birth.FundingHealth Research Council of New Zealand.

Changes on preterm morbidities with antenatal magnesium

Purpose: The effect of magnesium sulphate (MgSO4) to mothers with imminent premature birth at &amp;lt;34 weeks on neonatal morbidities like intraventricular hemorrhage, feeding intolerance, retinopathy or bronchopulmoner dysplasia is not clear. We evaluated the effect of antenatal magnesium sulfate exposure on premature early and late morbidities and mortality retrospectively.Materials and Methods: 108 infants ≤ 32 gestational age having antenatal magnesium were grouped as Mg (+) and 172 infants ≤ 32 gestational age not having antenatal magnesium were grouped as Mg (-).Results: Respiratory Distress Syndrome, intraventricular hemorrhage, severe intraventricular hemorrhage (grade 3 and 4), retinopathy of prematurity and bronchopulmonary dysplasia were less in Mg (+) group compared to Mg (-) group but it is not statistically significant, except Respiratory Distress Syndrome.Conclusion: This retrospective study showed that ante natal exposure to MgSO4 did not have statistically significant beneficial effect on either morbidities or mortality in premature infants.

489: Does antenatal magnesium sulfate exposure increase the risk of necrotizing enterocolitis in preterm neonates?

489: Does antenatal magnesium sulfate exposure increase the risk of necrotizing enterocolitis in preterm neonates?

Antenatal Magnesium Sulfate Exposure and Ponderal Index in Preterm Infants.

Antenatal magnesium sulfate (MgSO4) is known to affect the central nervous system of preterm infants, and there is biologic rationale for influence on other phenotypes. This study investigated the effect of MgSO4 exposure on the trajectory of ponderal index (PI, kg/m3) from birth to 2 years of age. A secondary analysis of a U.S. randomized controlled trial investigating MgSO4 versus placebo administration among women at high risk for preterm delivery was performed. Multivariable logistic regression was used to assess the relationship between PI from birth to 2 years of age and exposure to MgSO4 versus placebo. There was a larger decrement in PI from birth to 2 years of age in infants exposed to MgSO4 compared with placebo (p = 0.032). There was a statistically significant one-way interaction between newborn sex and treatment group (p = 0.019). Change in PI in males exhibited a greater decrement in those exposed to MgSO4 versus placebo (p = 0.227), whereas female infants exposed to MgSO4 had a smaller decrement (p = 0.04). MgSO4 exposure in preterm infants is associated with a larger decrease in PI from birth to 2 years of age. In addition, the direction of effect of MgSO4 on the change in PI over the first 2 years of life is different by sex.

Antenatal magnesium for preterm delivery reduces risk of cerebral palsy among surviving very preterm infants.

Commentary on: Rouse DJ, Hirtz DG, Thom E, Varner MW, Spong CY, Mercer BM, Iams JD, Wapner RJ, Sorokin Y, Alexander JM, Harper M, Thorp JM Jr, Ramin SM, Malone FD, Carpenter M, Miodovnik M, Moawad A, O'Sullivan MJ, Peaceman AM, Hankins GD, Langer O, Caritis SN, Roberts JM. Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Networks. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359(9):895–905. PMID 18753646. The current American College of Obstetricians and Gynecologists (ACOG) Committee Opinion supports the use of magnesium sulphate for foetal neuroprotection before 32 weeks of gestation 1. The clinical trial reviewed here is the largest and most recent to inform these guidelines 2. This randomised control trial (RCT), aimed to determine if the administration of magnesium sulphate to women at high risk of preterm delivery would reduce the risk of cerebral palsy (CP), found a reduction in moderate/severe CP at two years of age following antenatal magnesium sulphate exposure (RR 0.55, 95% CI 0.32–0.95) 2. These results were consistent with previous RCTs primarily evaluating the neuroprotective benefits of magnesium sulphate on the incidence of CP in preterm infants 3-5. Additionally, a Cochrane review concluded that 63 women were needed to prevent one diagnosis of CP 6. Further investigation is warranted to provide updated and unified guidelines regarding the use of magnesium sulphate for foetal neuroprotection. There was significant heterogeneity in treatment regimens between RCTs with no trial sharing the same loading dose, treatment dose, duration of dosing or retreatment regimen of magnesium sulphate 2-6. Additionally, although no serious maternal complications of antenatal magnesium exposure have been reported, there were several minor complications, including a 50% increase in maternal hypotension, leading to a 3.2-fold increase in cessation of therapy 6. Optimal treatment regimens would likely lead to a refined understanding of treatment effect size, better protocol adherence, and ultimately improved neurodevelopmental outcomes. The results of this trial should be considered in the context of advances in neonatal medicine affecting neurodevelopmental outcomes. Specifically, during the time of this study's enrolment, the American Academy of Pediatrics (AAP) recommended against routine use of postnatal corticosteroids in preterm infants because of its negative effect on neurodevelopmental outcomes 7. This recommendation significantly curtailed the use of early postnatal steroids, potentially altering neurodevelopmental outcomes if differed between treatment groups 7. Additionally, there has been increased survival of infants 22–23 weeks of gestation 8. Currently, there are no RCTs that investigate the neuroprotective benefit of magnesium sulphate in <24 weeks of gestation. It has been 20 years since recruitment started and nearly 10 years since the publication of this landmark trial has influenced the practice of obstetricians in the United States 2. In that same time, there continue to be advances in the care of extremely low birthweight infants impacting changes in survival and neurodevelopmental outcomes. Although many institutions follow ACOG recommendations of administering antenatal magnesium sulphate in preterm delivery, there are no recommendations for magnesium sulphate treatment regimens or gestational age thresholds presumably leading to a variety of clinical practices 1. Perhaps it is time to repeat this clinical trial in a new era to help elucidate both the optimal treatment regimen as well as the effect of antenatal magnesium exposure in the setting of preterm labour and delivery on neurodevelopmental outcomes. In the meantime, this trial remains consistent with available evidence supporting antenatal magnesium sulphate exposure in preterm infants to reduce CP. https://ebneo.org/2017/10/antenatal-magnesium-for-preterm-delivery-reduces-risk-of-cerebral-palsy-among-surviving-very-preterm-infants/ None. None.

Antenatal Exposure to Magnesium Sulfate Is Associated with Reduced Cerebellar Hemorrhage in Preterm Newborns

To determine the association of antenatal magnesium sulfate with cerebellar hemorrhage in a prospective cohort of premature newborns evaluated by magnetic resonance imaging (MRI). Cross-sectional analysis of baseline characteristics from a prospective cohort of preterm newborns (<33 weeks gestation) evaluated with 3T-MRI shortly after birth. Exclusion criteria were clinical evidence of a congenital syndrome, congenital infection, or clinical status too unstable for transport to MRI. Antenatal magnesium sulfate exposure was abstracted from the medical records and the indication was classified as obstetric or neuroprotection. Two pediatric neuroradiologists, blinded to the clinical history, scored axial T2-weighted and iron susceptibility MRI sequences for cerebellar hemorrhage. The association of antenatal magnesium sulfate with cerebellar hemorrhage was evaluated using multivariable logistic regression, adjusting for postmenstrual age at MRI and known predictors of cerebellar hemorrhage. Cerebellar hemorrhage was present in 27 of 73 newborns (37%) imaged at a mean ± SD postmenstrual age of 32.4 ± 2 weeks. Antenatal magnesium sulfate exposure was associated with a significantly reduced risk of cerebellar hemorrhage. Adjusting for postmenstrual age at MRI, and predictors of cerebellar hemorrhage, antenatal magnesium sulfate was independently associated in our cohort with decreased cerebellar hemorrhage (OR, 0.18; 95% CI, 0.049-0.65; P = .009). Antenatal magnesium sulfate exposure is independently associated with a decreased risk of MRI-detected cerebellar hemorrhage in premature newborns, which could explain some of the reported neuroprotective effects of magnesium sulfate.

Antenatal Magnesium Sulfate Exposure and Acute Cardiorespiratory Events in Preterm Infants

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Antenatal magnesium sulfate exposure and acute cardiorespiratory events in preterm infants

Antenatal magnesium (anteMg) is used for various obstetric indications including fetal neuroprotection. Infants exposed to anteMg may be at risk for respiratory depression and delivery room (DR) resuscitation. The study objective was to compare the risk of acute cardiorespiratory events among preterm infants who were and were not exposed to anteMg. This was a retrospective analysis of prospective data collected in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network's Generic Database from April 1, 2011, through March 31, 2012. The primary outcome was DR intubation or respiratory support at birth or on day 1 of life. Secondary outcomes were invasive mechanical ventilation, hypotension treatment, neonatal morbidities, and mortality. Logistic regression analysis evaluated the risk of primary outcome after adjustment for covariates. We evaluated 1544 infants <29 weeks' gestational age (1091 in anteMg group and 453 in nonexposed group). Mothers in the anteMg group were more likely to have higher education, pregnancy-induced hypertension, and antenatal corticosteroids, while their infants were younger in gestation and weighed less (P < .05). The primary outcome (odds ratio [OR], 1.2; 95% confidence interval [CI], 0.88-1.65) was similar between groups. Hypotension treatment (OR, 0.70; 95% CI, 0.51-0.97) and invasive mechanical ventilation (OR, 0.54; 95% CI, 0.41-0.72) were significantly less in the anteMg group. Among preterm infants age <29 weeks' gestation, anteMg exposure was not associated with an increase in cardiorespiratory events in the early newborn period. The safety of anteMg as measured by the need for DR intubation or respiratory support on day 1 of life was comparable between groups.

Influence of Antenatal Magnesium Sulfate Exposure on Perinatal Outcomes in VLBW Infants with Maternal Preeclampsia

Influence of Antenatal Magnesium Sulfate Exposure on Perinatal Outcomes in VLBW Infants with Maternal Preeclampsia

Neonatal Medical Admission in a Term and Late-preterm Cohort Exposed to Magnesium Sulfate

Objective The purpose of this study was to estimate neonatal intensive care unit and special care unit (NICU) admission rates and care needs among term and late-preterm neonates who are exposed to antenatal magnesium sulfate. Study Design We conducted a retrospective cohort study of all singleton neonates of ≥35 weeks' gestation who were exposed immediately antenatally to magnesium sulfate for maternal eclampsia prophylaxis (August 2006 through July 2008). Results Fifty-one of 242 neonates (21.1%) who, at ≥35 weeks' gestation, had been exposed to antenatal magnesium sulfate were admitted to the NICU. NICU admission was associated in a dose-dependent fashion with total hours and mean dose of magnesium: >12 hours exposure, odds ratio, 2.81 (95% confidence interval, 1.31–6.03); >30 g exposure, odds ratio, 2.59 (95% confidence interval, 1.22–5.51). Infants in NICU who were diagnosed with hypermagnesemia required fluid or nutritional support more frequently (91.3% vs 39.3%; P Conclusion Antenatal magnesium sulfate exposure is associated with NICU admission among term and late-preterm neonates in a dose-dependent fashion. Fluid and nutritional assistance commonly are needed in this cohort.

A case-control study on association between antenatal exposure to magnesium sulfate and patent ductus arteriosus in preterm infants

Objective To identify the association between antenatal exposure to magnesium sulfate and patent ductus arteriosus（PDA） in preterm infants. Methods A 1 ： 1 case-control study was conducted on 93 preterm infants with PDA and 93 cases of matched controls without PDA hospitalized in our neonatal intensive care unit between January 2008 and December 2009. Information on antenatal exposure to magnesium sulfate, neonatal birth weight and other perinatal factors was collected and analyzed with univariate analysis, multivariate Logistic regression analysis. Results There were 51 preterm infants exposed to magnesium sulfate antenatally in PDA group and 34 infants in controls. The median （P25-P75） level of neonatal serum magnesium in PDA cases was 0.98 mmol/L （0.92-1.32 mmol/L） ,significantly higher than that in controls [0.90 mmol/L（0. 82-1. 09） mmol/L] （Z = 3.56, P=0.00）. Logistic regression analysis showed that PDA in preterm infants was significantly associated with antenatal magnesium sulfate exposure（OR=2. 646,95 %CI： 1. 356-5. 163, P=0.004）, fetal distress （OR= 7. 189, 95% CI：1.209-42.756, P=0.030）, neonatal birth weight （OR = 1. 842,95 % CI ： 1. 087-3. 438, P = 0. 049 ）, respiratory failure （OR = 3. 499,95 % CI ： 1.256- 9. 752, P=0. 017）and postnatal oxygen inhalation （OR=O. 482,95% CI：0. 233-0. 999, P=0. 045）. Also, a significant positive correlation was found between PDA and the dose of magnesium sulfate and the concentrations of serum magnesium in preterm infants （Хtrend^ 2= 7.41, P= 0. 007 ;Хtrend^ 2 = 12. 13, P= 0. 000）. Conclusions Antenatal exposure to magnesium sulfate might increase the risk of PDA in preterm infants. Key words: Infant, premature; Ductus arteriosus, patent; Magnesium sulfate

Antenatal magnesium exposure and neonatal demise

Objective: To assess the effect of antenatal magnesium sulfate exposure on neonatal demise. Study Design: A retrospective analysis of prospectively captured data from 100 tertiary centers between May 1997 and January 2000 was performed. Included were nonanomalous newborns who were admitted to the neonatal intensive care unit between 23 and 34 completed weeks' gestation. Predictors of neonatal demise were determined from a pool of 24 candidate variables in a univariate analysis. A multivariate predictive model for mortality was constructed by using the variables that had significant interactions with the rate of demise (P ≤.1). Results: A total of 12,876 cases were available for analysis. When these cases were stratified according to gestational age, magnesium was associated with a significant reduction in neonatal demise (OR, 0.67; 95% CI, 0.54 to 0.84; P =.0005). The effect remained when controlling for both gestational age and indication for therapy (adjusted OR, 0.70; 95% CI, 0.56 to 0.89; P =.003). The effect was similar in direction and magnitude in the final model after controlling for additional antenatal factors (OR, 0.82; 95% CI, 0.65 to 1.04;P: =.108). Conclusion: Antenatal magnesium exposure is not associated with neonatal death, regardless of indication for therapy. (Am J Obstet Gynecol 2001;185: 869-72.)

Antenatal magnesium sulphate exposure is associated with prolonged parathyroid hormone suppression in preterm neonates

Antenatal magnesium sulphate exposure is associated with prolonged parathyroid hormone suppression in preterm neonates

Antenatal magnesium sulphate exposure is associated with prolonged parathyroid hormone suppression in preterm neonates

Antenatal magnesium sulphate exposure is associated with prolonged parathyroid hormone suppression in preterm neonates

Antenatal magnesium sulphate exposure is associated with prolonged parathyroid hormone suppression in preterm neonates

The effects of maternal magnesium sulphate treatment on neonatal mineral status and parathyroid hormone secretory response were studied in 8 exposed and 27 control preterm infants during the first 2 wk of life. Antenatal magnesium sulphate resulted in hypermagnesaemia during the first 3-7 d of life without affecting other serum mineral concentrations. Early hypermagnesaemia was associated with hypercalciuria during the first 3 d and parathyroid hormone suppression up to the age of 2 wk in the exposed infants.