MgSO4 Therapy Research Articles

The performance of the practices associated with the occurrence of severe intraventricular hemorrhage in the very premature infants: data analysis from the Chinese neonatal network

BackgroundThe occurrence of severe intraventricular hemorrhage (sIVH) was high in the very preterm infants (VPIs) in China. The management strategies significantly contributed to the occurrence of sIVH in VPIs. However, the status of the perinatal strategies associated with sIVH for VPIs was rarely described across the multiple neonatal intensive care units (NICUs) in China. We aim to investigate the characteristics of the perinatal strategies associated with sIVH for VPIs across the multiple NICUs in China.MethodsThis was a retrospective analysis of data from a prospective cohort of Chinese Neonatal Network (CHNN) dataset, enrolling infants born at 24+0—31+6 from 2019 to 2021. Eleven perinatal practices performed within the first 3 days of life were investigated including antenatal corticosteroids use, antenatal magnesium sulphate therapy, intubation at birth, placental transfusion, need for advanced resuscitation, initial inhaled gas of 100% FiO2 in delivery room, initial invasive respiratory support, surfactant and caffeine administration, early enteral feeding, and inotropes use. The performances of these practices across the multiple NICUs were investigated using the standard deviations of differences between expected probabilities and observations. The occurrence of sIVH were compared among the NICUs.ResultsA total of 24,226 infants from 55 NICUs with a mean (SD) gestational age of 29.5 (1.76) and mean (SD) birthweight of 1.31(0.32) were included. sIVH was detected in 5.1% of VPIs. The rate of the antenatal corticosteroids, MgSO4 therapy, and caffeine was 80.0%, 56.4%, and 31.5%, respectively. We observed significant relationships between sIVH and intubation at birth (AOR 1.52, 95% CI 1.13 to 1.75) and initial invasive respiratory support (AOR 2.47, 95% CI 2.15 to 2.83). The lower occurrence of sIVH (4.8%) was observed corresponding with the highest utility of standard antenatal care, the lowest utility of invasive practices, and early enteral feeding administration.ConclusionsThe current evidence-based practices were not performed in each VPI as expected among the studied Chinese NICUs. The higher utility of the invasive practices could be related to the occurrence of sIVH.

School-Age Outcomes of Antenatal Magnesium Sulphate in Preterm Infants.

Antenatal magnesium sulphate (MgSO4) therapy given to women at risk of preterm birth reduced the risk of cerebral palsy in early childhood. However, its effect on longer-term neurological outcomes remains uncertain. This study aimed to assess the effects of antenatal MgSO4 therapy on school-age outcomes of preterm infants. We conducted a systematic review and meta-analysis. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL for randomized controlled trials (RCTs). Two reviewers independently evaluated the eligibility for inclusion and extracted data. Ten RCTs were included. Only two of them were on school-age outcomes. Antenatal MgSO4 therapy had no impact on cerebral palsy, hearing impairment, neurosensory disability, and death at school-age. Meta-analysis on mental retardation and visual impairment was not able to be performed due to different methods of evaluation. In the analysis of short-term outcomes conducted as secondary outcomes, antenatal MgSO4 therapy increased the risk of maternal adverse events with any symptom (3 RCTs; risk ratio 2.79; 95% confidence interval 1.10 to 7.05, low certainty of evidence) but was not associated with any neonatal symptoms. The number of cases was insufficient to determine the impact of antenatal MgSO4 therapy on school-age outcomes. Further accumulation of long-term data is required.

Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Treated with Magnesium Sulfate: A Systematic Review with Meta-analysis

To assess magnesium sulfate (MgSO4) as a neuroprotective agent in hypoxic-ischemic encephalopathy. For this systematic review, PubMed, EMBASE, the Cochrane Library, EMCARE, and MedNar were searched in November 2022 for randomized controlled trials (RCTs). Meta-analysis was conducted using Stata 16.0 and RevMan 5.3. Twenty RCTs with a total sample size of 1485 were included, of which 16 were from settings where therapeutic hypothermia (TH) was not offered. Regarding MgSO4 in settings where TH was not offered, only 1 study evaluated composite outcome of death or disability at ≥18months and reported such poor outcome in 8 of 14 control infants and 4 of 8 in the MgSO4 group. MgSO4 was not associated with mortality (RR, 0.86; 95% CI, 0.72-1.03; 13 RCTs) or hypotension (RR, 1.02; 95% CI, 0.88-1.18; 5 RCTs). Thirteen studies reported that MgSO4 improved in-hospital outcomes, such as reduced seizure burden and improved neurological status at discharge. MgSO4 reduced the risk of poor suck feeds (RR, 0.52; 95% CI, 0.40-0.68; 6RCTs) and abnormal electroencephalogram (RR, 0.64; 95% CI, 0.45-0.93; 5 RCTs). Certainty of evidence was moderate for mortality and low or very low for other outcomes. For studies with MgSO4 as an adjunct to TH, none reported on death or neurodevelopmental disability at ≥18months. MgSO4 was not associated with mortality (RR, 0.65; 95% CI, 0.34-1.27; 3 RCTs) or hypotension (RR, 1.0; 95% CI, 0.71-1.40; 3 RCTs). Evidence around long-term outcomes of MgSO4 when used with or without TH was scant. MgSO4 therapy may improve in-hospital neurological outcomes without affecting mortality in settings where TH is not offered. Well-designed RCTs for neuroprotection are needed, especially in low-resource settings. "Open Science Forum" (https://doi.org/10.17605/OSF.IO/FRM4D).

Antenatal magnesium sulfate and the need for mechanical ventilation in the first three days of life

Antenatal administration of magnesium sulfate (MgSO4) to women in preterm labor has gained widespread use. This study examined the relationship between MgSO4 exposure with neonatal respiratory outcomes. Very low birth weight (VLBW) infants exposed to antenatal MgSO4 were included. Infants who were intubated anytime during the first three days of life were compared to those who were not intubated regarding their demographic and clinical characteristics, MgSO4 therapy, immediate respiratory outcomes, and occurrence of intraventricular hemorrhage (IVH) using student t-test, chi square testing and logistic regression analysis to control for confounding variables. Correlation coefficient of MgSO4 cumulative dose given and duration of infusion with delivery room resuscitation and need for mechanical ventilation in the first 3 days of life were also calculated. Multilinear regression analysis was used to control for confounding factors. Intubated group included 96 infants while non-intubated group included 171 infants. Although, intubated group has younger gestational age (26 vs. 29 weeks, p<0.01) and lower birth weight (786 vs. 1115g (g), p<0.01), there were no significant differences between groups in regard to MgSO4 cumulative dose (24 vs. 27g, p=0.29), infusion time (14.6 vs. 18h, p=0.19) or infants' serum magnesium level (2.6 vs. 2.8 milliequivalents (mEq)/L p=0.86). There was no correlation between cumulative MgSO4 dose with endotracheal intubation or cardiac resuscitation in the delivery room (cc: -0.03, p=0.66; and 0.02, p=0.79, respectively) or the need for mechanical ventilation in the first 3 days of life (cc: -0.04 to -0.07, p=0.21-0.51). In addition, there was no relationship between MgSO4 dose, duration of infusion, or infant's serum magnesium level and occurrence of IVH. Regardless of dose or duration of infusion, antenatal MgSO4 exposure is not associated with increased intubation or mechanical ventilation early in life.

Impact of magnesium sulfate therapy in improvement of renal functions in high fat diet-induced diabetic rats and their offspring

The role of magnesium sulfate (MgSO4) administration to prevent diabetic nephropathy (DN) by reducing insulin resistance (IR) and the relationship of this action with gender and the expression of NOX4 and ICAM1 genes in the parents and their offspring were studied. Males and females rat, and their pups were used. Type 2 diabetes induced by high-fat diet (HFD) administration and a low dose of streptozotocin. Animals were divided into the: non-treated diabetic (DC), the diabetic group received insulin (Ins), and the diabetic group received MgSO4. Two groups of parents received just a normal diet (NDC). Following each set of parents for 16 weeks and their pups for 4 months, while eating normally. We assessed the amount of water consumed, urine volume, and blood glucose level. The levels of glucose, albumin, and creatinine in the urine were also measured, as well as the amounts of sodium, albumin, and creatinine in the serum. Calculations were made for glomerular filtration rate (GFR) and the excretion rates of Na and glucose fractions (FE Na and FE G, respectively). The hyperinsulinemic-euglycemic clamp was done. NOX4 and ICAM1 gene expressions in the kidney were also measured. MgSO4 or insulin therapy decreased blood glucose, IR, and improved GFR, FE Na, and FE G in both parents and their offspring compared to D group. MgSO4 improved NOX4 and ICAM1 gene expressions in the parents and their offspring compared to D group. Our results indicated that MgSO4 could reduce blood glucose levels and insulin resistance, and it could improve kidney function.

Correlation between magnesium sulphate exposure in utero and serum calcium and alkaline phosphatase levels in preterm infants

Magnesium sulphate (MgSO4) is administered to pregnant women at risk of preterm labour and eclampsia. Since prolonged exposure to antenatal MgSO4 is considered to be a risk factor for infant skeletal demineralization, we evaluated infants exposed to antenatal MgSO4 for bone and mineral metabolism using their umbilical cord blood. The study population comprised 137 preterm infants. Forty-three infants were exposed (exposure group) and 94 infants were not exposed (control group) to antenatal MgSO4. Blood samples from the umbilical cords and infants were analysed with respect to mineral metabolism, intact parathyroid hormone (iPTH) level, and alkaline phosphatase (ALP) level. Correlation between the level of these parameters and the duration and dosage of MgSO4 was also examined. Preterm infants in the exposure group were antenatally exposed to MgSO4 for a median (IQR) period of 14 (5-34) days and a dosage of 447 (138-1118) g. Serum calcium levels were lower (8.8 vs 9.4 mg/dL, p<0.001) and ALP levels were higher (312 vs 196 U/L, p<0.001) in the exposure group. Serum calcium levels did not correlate with MgSO4 administration dosage and therapy duration, however, ALP levels correlated with the duration and total dosage of MgSO4 (Spearman's rank correlation r [95% confidence interval]: 0.55 [0.30-0.73], p <0.001 and 0.63 [0.40-0.78], p <0.001, respectively). Prolonged periods and higher doses of antenatal MgSO4 exposure can cause in utero abnormal bone metabolism in preterm infants.

Ultrasonographic Changes in Transorbital Measurement of Optic Nerve Sheath Diameter in Magnesium Sulfate-Treated Severely Preeclamptic Patients: A Prospective Observational Study.

Severe preeclampsia can lead to various complications including increased intracranial pressure (ICP) which can be catastrophic but difficult to detect because of variable nonspecific symptoms. Ultrasonography has been used as noninvasive measure to monitor optic nerve sheath diameter (ONSD) as a marker of raised ICP. Effect of MgSO4 on ICP can modify the management approach, need for additional monitoring, targeting hemodynamic goals, timing of delivery, and choice of anesthesia. We evaluated the effect of MgSO4 on raised ICP in severely preeclamptic patients using ultrasound-guided ONSD as a surrogate marker of ICP. This prospective observational study was conducted after ethical committee approval and written informed consent from patients. Ultrasound-guided ONSD was measured and compared in 47 severe preeclamptic patients before and at 1 h, 4 h, 12 h, and 24 h after starting MgSO4 therapy. The analysis of data was done by one-way analysis of variance using Statistical Package for the Social Science. Mean ONSD was 5.56 ± 0.30 mm in our study group. ONSD above 5.8 mm was seen in 17 (36.17%) patients and was considered as marker of raised ICP. There was a significant decrease in ONSD after 4 h of administration of MgSO4. No significant correlation was observed between mean arterial pressure, serum magnesium level, and ONSD. Ultrasound-guided ONSD measurement can be used as a quick, noninvasive bedside tool in severe preeclamptic patient on MgSO4 treatment as marker of ICP which help us in determining clinical severity, therapeutic response, and to decide further course of management.

Combination Therapy with GABA and MgSO4 Improves Insulin Sensitivity in Type 2 Diabetic Rat.

Background Gamma-aminobutyric acid (GABA) and magnesium sulfate (MgSO4) play a crucial role in glycemic control. Therefore, we studied the effect of combination therapy with GABA and MgSO4 to improve insulin sensitivity in diabetes induced by streptozotocin as well as high-fat diet in a diabetic rat model. Design and Methods. Forty randomly selected rats were assigned to four groups: nondiabetic control group was fed the normal diet, insulin-resistant diabetic rat model was induced by streptozotocin and high-fat diet, GABA + MgSO4 group received GABA and MgSO4, and insulin group was treated with insulin. Body weight, abdominal fat, blood glucose, serum insulin, and glucagon concentration were measured. The glucose clamp technique, glucose tolerance test, and insulin tolerance test were performed to study insulin sensitivity. Also, the expressions of glucose 6 phosphatase, glucagon receptor, and phosphoenolpyruvate carboxykinase genes in liver were assessed for the gluconeogenesis pathway. Protein translocation and glucose transporter 4 (Glut4) genes expression in muscle were also assessed. Results Combination of GABA + MgSO4 or insulin therapy enhanced insulin level, glycemic control, glucose and insulin tolerance test, some enzymes expression in the gluconeogenesis pathway, body fat, body weight, and glucagon receptor in diabetic rats. Moreover, an increase was observed in protein and gene expression of Glut4. Insulin sensitivity in combination therapy was more than the insulin group. Conclusions GABA and MgSO4 enhanced insulin sensitivity via increasing Glut4 and reducing the gluconeogenesis enzyme and glucagon receptor gene expressions.

Prenatal therapy with magnesium sulphate and intestinal obstruction due to meconium in preterm newborns

IntroductionMagnesium sulphate (MgSO4) therapy has shown to be useful as a neurological protector in the preterm newborn below 32 weeks of gestation. The most documented adverse effect is cardiorespiratory failure, whereas its relationship with meconium obstruction is controversial. The main objective of this study was to analyse the possible association between prenatal MgSO4 therapy and meconium obstruction. Patients and methodsAn analytical retrospective study was conducted on <32 weeks preterm babies admitted to a tertiary-level hospital (January 2016–December 2017). Epidemiological, prenatal and postnatal data on the outcomes were obtained, analysed and compared in both groups (exposed to MgSO4 and not exposed). ResultsThe study included 201 patients (146 exposed and 55 non-exposed). There were no significant differences in the mean gestational age (28.4 ± 2.2 vs. 28.7 ± 2.8 weeks, respectively), or in the rest of epidemiological and perinatal variables. Prenatal corticosteroid therapy was more frequent in the MgSO4 group (75.9 vs. 53.7%; p = .002), and in the non-exposed group there were more multiple pregnancies (52.7 vs. 36.6%; p = .027), and female gender (56.4 vs. 37%; p = .013). There were no statistically significant differences in the presence of meconium obstruction (75.9% in exposed vs. 67.3% in non-exposed; p = .23), although repeated rectal stimulation was more frequent in the exposed group (43.2 vs. 27.9%; p = .08). Furthermore, there were no significant differences in the main cardiorespiratory variables: 1-min Apgar score (6.2 in MgSO4− exposed vs. 5.6 in non-exposed; p = .75), 5-min Apgar score (7.9 vs. 7.6; p = .31), advanced newborn resuscitation (26 vs. 31.5%; p = .44), maximum FiO2 (45.5 vs. 48; p = .58), and initial inotropic requirements (10.3 vs. 20.8%; p = .55). ConclusionsThis study found no correlations between MgSO4 therapy and meconium obstruction or cardiorespiratory failure.

Beneficial effects of MgSO4 on TFAM, UPC3 and FNDC5 mRNA expressions in skeletal muscle of type 2 diabetic rats: a possible mechanism to improve insulin resistance

Hypomagnesemia has been associated with development of type 2 diabetesmellitus (T2DM) and its complications. Irisin has beneficial effects on glucose uptake and improves hepatic glucose and lipid metabolism. In this study, we aimed to evaluate the effects of long-term treatment of MgSO4 and insulin on insulin resistance, dyslipidemia, serum and hepatic irisin levels, skeletal muscle gene expression of fibronectin type III domain-containing protein 5 (FNDC5), mitochondrial transcription factor A (TFAM) and mitochondrial uncoupling protein 3 (UCP3) in T2DM rats. Twenty-four rats were divided into four groups: Control group, diabetic control (DC) using a high-fat diet + streptozotocin, insulin-treated diabetic group (DC + Ins), MgSO4-treated diabetic group (DC + Mg). At the end of therapies, serum concentrations of FBG, TG, insulin, Ox-LDL, along with serum and hepatic irisin levels were measured. FNDC5, TFAM, and UCP3 mRNA expressions were measured in the skeletal muscle by Real-time PCR. In comparison with DC group, MgSO4 therapy resulted in decreased FBG, TG, Ox-LDL, improved serum insulin and irisin levels, and increased mRNA expressions of FNDC5, UCP3 and TFAM. Insulin therapy significantly decreased FBG, Ox-LDL, FNDC5 and serum irisin levels compared with the control group. While, insulin therapy markedly increased TFAM and UCP3 compared with the DC group. In conclusion, MgSO4 can improve insulin resistance and hyperlipidemia partly through decreasing Ox-LDL, increasing serum irisin levels as well as increasing FNDC5, TFAM, and UCP3 mRNA expressions in T2DM rats. These findings can be considered in the management of diabetes treatment.

Lack of nitric oxide bioavailability in early pregnancy predisposes to dyslipidemia and surges preeclampsia and fetal growth retardation

Background: Hyperlipidemia has been reported in preeclampsia (PrE) and is linked to poor pregnancy outcome and long-term cardiovascular complications. This study aimed to elucidate the relationship between nitric oxide (NO) and blood lipids levels during normal pregnancy and in NG-nitro-l-arginine methyl ester (L-NAME) - induced preeclampsia before and after magnesium sulphate (MgSO4) therapy and its effect on the pregnancy outcome.Methods: Forty female Wistar rats were divided into four groups: non pregnant (NP) group - non pregnant healthy rats receiving no treatment, control pregnant (Con-P) group - control pregnant rats receiving no treatment, pregnant (PE) group - pregnant animals with untreated PrE, and the pregnant MgSO4 (PE-Mg) group - pregnant animals with PrE- treated with MgSO4. The nitric oxide synthase inhibitor L-NAME was used to induce experimental model of PrE in the PE and the PE-Mg groups. The changes in total NO production, total cholesterol (TC), triglycerides (TG), low density lipoproteins (LDL-C), high density lipoproteins (HDL), LDL-C/HDL-C ratio, soluble vascular endothelial growth factor receptor-1 (sVEGFR1) also known as sFlt-1, blood pressure, kidney functions, body weight, and pregnancy outcome were assessed.Results: Decreased NO production in the PE group was associated with elevated TC, TG, LDL-C/HDL-C ratio, hypertension, proteinuria, increased urea, creatinine, and sFlt-1 levels, and poor pregnancy outcome demonstrated by high pup mortality rate and low birth weight. Increased NO production in the PE-Mg group treated with MgSO4 therapy was associated with decreased signs of preeclampsia and hypolipidemia and increased pup viability and birth weight.Conclusions: NO bioavailability is crucial for the homeostasis of the lipid profile in normal pregnancy and the prevention of preeclampsia. Routine periodic assessments of the blood lipid profile and the NO production in the pregnant females may be a helpful tool in early prediction of preeclampsia.

Impaired neuromuscular function by conjoint actions of organophosphorus insecticide metabolites omethoate and cyclohexanol with implications for treatment of respiratory failure

Background Ingestion of agricultural organophosphorus insecticides is a significant cause of death in rural Asia. Patients often show acute respiratory failure and/or delayed, unexplained signs of neuromuscular paralysis, sometimes diagnosed as “Intermediate Syndrome”. We tested the hypothesis that omethoate and cyclohexanol, circulating metabolites of one agricultural formulation, cause muscle weakness and paralysis. Methods Acetylcholinesterase activity of insecticide components and metabolites was measured using purified enzyme from eel electroplaque or muscle homogenates. Mechanomyographic recording of pelvic limb responses to nerve stimulation was made in anaesthetized pigs and isometric force was recorded from isolated nerve-muscle preparations from mice. Omethoate and cyclohexanol were administered intravenously or added to physiological saline bathing isolated muscle. We also assessed the effect of MgSO4 and cooling on neuromuscular function. Results Omethoate caused tetanic fade in pig muscles and long-lasting contractions of the motor innervation zone in mouse muscle. Both effects were mitigated, either by i.v. administration of MgSO4 in vivo or by adding 5 mM Mg2+ to the medium bathing isolated preparations. Combination of omethoate and cyclohexanol initially potentiated muscle contractions but then rapidly blocked them. Cyclohexanol alone caused fade and block of muscle contractions in pigs and in isolated preparations. Similar effects were observed ex vivo with cyclohexanone and xylene. Cyclohexanol-induced neuromuscular block was temperature-sensitive and rapidly reversible. Conclusions The data indicate a crucial role for organophosphorus and solvent metabolites in muscle weakness following ingestion of agricultural OP insecticide formulations. The metabolites omethoate and cyclohexanol acted conjointly to impair neuromuscular function but their effects were mitigated by elevating extracellular Mg2+ and decreasing core temperature, respectively. Clinical studies of MgSO4 therapy and targeted temperature management in insecticide-poisoned patients are required to determine whether they may be effective adjuncts to treatment.

Abbreviated (8 hours) versus Traditional (24 hours) Postpartum MgSO4 Prophylaxis in Severe Preeclampsia: A Randomised Control Trial

Introduction: Preeclampsia is a multisystem disorder affecting pregnancy after 20 weeks of gestation featured by hypertension and proteinuria. Magnesium Sulphate (MgSO4) has been used for 24 hours following delivery to prevent eclampsia in patients with severe preeclampsia. Aim: To determine the need to continue magnesium sulphate therapy 8 hours following delivery. Materials and Methods: The double blinded randomised controlled study was performed in the Department of Gynaecology and Obstetrics at R.G. Kar Medical College, Kolkata, West Bengal, India, from 1st July 2015 to 30th June 2016. Total 90 patients with severe preeclampsia were randomised in two group. In group A MgSO4 was discontinued 8 hours following delivery (abbreviated group) and in the group B it was continued for 24 hours following delivery (traditional group). The primary objective of study was to determine the need to continue MgSO4 therapy 8 hours following delivery. Secondary objectives were monitoring time by doctors, nursing care time, postpartum ambulation time, duration of urinary catheterisation, minor complication like urinary tract infection, duration and total dose of MgSO4 therapy. In order to calculate statistical significance of the different variables in between two groups, Student’s independent sample’s t-test was used for normally distributed numerical values and Chi-square test or Fischer’s-exact test was used for unpaired proportion data. Results: In abbreviated group, the number of patients (n=1) who did not need to continue MgSO4 therapy beyond 8 hours following delivery as safety measures were statistically significant (p-value &lt;0.0001) in comparison to traditional group. Total duration and dose of MgSO4 therapy were significantly less (p-value &lt;0.0001) in the abbreviated group. There was statistically significant reduction in time from delivery to postpartum ambulation and duration of indwelling urinary catheter in the abbreviated group. Conclusion: The abbreviated (8 hours) regime of postpartum MgSO4 for seizure prophylaxis is a suitable alternative to the traditional (24 hours) regime.

The benefit of nebulized magnesium sulphate therapy in patients with acute severe asthma: a scoping review

OBJECTIVE It is known that magnesium sulfate (MgSO4) administered intravenously as an adjunct treatment is effective in treating asthma exacerbations. However, there is limited data available on the use and benefit of nebulized magnesium sulfate. METHODS We conducted a scoping review on four databases i.e., Medline, Embase, PubMed, and Cochrane to determine the benefit of using nebulized magnesium sulphate therapy in addition to salbutamol and/or ipratropium in the treatment of patients with severe acute asthma. RESULTS A total of 16 articles were included in the study. Based on the literature review, combined nebulized MgSO4 and salbutamol therapy was found to be superior to salbutamol alone in adult patients. There was also a significant reduction in hospital admissions in adult patients with severe asthma exacerbations if they receive nebulized MgSO4. Although some small studies have shown benefit in using it in children and pregnant patients, further studies are needed to address the role of nebulised MgSO4 in such populations. CONCLUSION Within the study limitations, magnesium sulfate was found to be beneficial when used in nebulized form in acute asthma exacerbation. Further studies are warranted to establish its role in practice guidelines.

Terapia prenatal con sulfato de magnesio y obstrucción intestinal por meconio en recién nacidos pretérmino

IntroductionMagnesium sulphate (MgSO4) therapy has shown to be useful as a neurological protector in the preterm newborn below 32 weeks of gestation. The most documented adverse effect is cardiorespiratory failure, whereas its relationship with meconium obstruction is controversial.The main objective of this study was to analyse the possible association between prenatal MgSO4 therapy and meconium obstruction. Patients and methodsAn analytical retrospective study was conducted on < 32 weeks preterm babies admitted to a tertiary-level hospital (January 2016-December 2017). Epidemiological, prenatal and postnatal data on the outcomes were obtained, analysed and compared in both groups (exposed to MgSO4 and not exposed). ResultsThe study included 201 patients (146 exposed and 55 non-exposed). There were no significant differences in the mean gestational age (28.4 ± 2.2 vs. 28.7 ± 2.8 weeks, respectively), or in the rest of epidemiological and perinatal variables. Prenatal corticosteroid therapy was more frequent in the MgSO4 group (75.9 vs. 53.7%; p = .002), and in the non-exposed group there were more multiple pregnancies (52.7 vs. 36.6%; p = .027), and female gender (56.4 vs. 37%; p = .013). There were no statistically significant differences in the presence of meconium obstruction (75.9% in exposed vs. 67.3% in non-exposed; p = .23), although repeated rectal stimulation was more frequent in the exposed group (43.2 vs. 27.9%; p = .08). Furthermore, there were no significant differences in the main cardiorespiratory variables: 1-minute Apgar score (6.2 in MgSO4- exposed vs. 5.6 in non-exposed; p = .75), 5-minutes Apgar score (7.9 vs. 7.6; p = .31), advanced newborn resuscitation (26 vs. 31.5%; p = .44), maximum FiO2 (45.5 vs. 48; p = .58), and initial inotropic requirements (10.3 vs. 20.8%; p = .55). ConclusionsThis study found no correlations between MgSO4 therapy and meconium obstruction or cardiorespiratory failure.

Magnesium Sulfate Administration in Moderate Coronary Artery Disease Patients Improves Atherosclerotic Risk Factors: A Double-Blind Clinical Trial Study.

Magnesium (Mg) deficiency is known to promote vascular and cardiac dysfunctions such as atherosclerosis. This study investigated the effect of oral MgSO4 therapy to improve lipid profile and serum oxidized LDL level and its receptor (LOX1) in moderate coronary atherosclerotic patients. In this randomized double-blind placebo-controlled clinical trial study, 64 patients with moderate coronary artery disease were selected according to angiography findings. Participants were divided into 2 groups including Mg-treated (n = 32) and placebo (n = 32) The patients received either placebo or MgSO4 supplement capsule, containing 300 mg MgSO4 for 6 months on a daily basis. Lipid profile, HbA1c, 2h postprandial (2hpp) blood glucose, fasting blood sugar, serum glutamate oxaloacetate transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), oxidized low-density lipoprotein, and lectin-like ox-LDL receptor 1 (LOX1) concentrations were measured at baseline and every 3 months. HbA1c, serum LOX1, and oxidized low-density lipoprotein concentrations were significantly lower in the Mg-treated group than the placebo group 3 months after MgSO4 administration. 2hpp, serum low-density lipoprotein cholesterol, SGPT, SGOT levels, and HbA1c levels significantly improved in the Mg-treated group compared with the placebo-received group. Overall, the results of this study showed that magnesium treatment improved some of the major risk factors of atherosclerosis. According to the results of liver function tests (SGOT and SGPT), magnesium therapy seems to be safe in patients with moderate atherosclerotic plaque. Therefore, it is suggested that magnesium to be used along with other atherosclerosis control drugs.

21: Cerebral autoregulation in eclampsia

Eclampsia is the occurrence of tonic-clonic seizures in pregnant or recently postpartum women with preeclampsia. The etiology of these convulsions is unknown. Cerebral autoregulation (CA) is a physiological process that maintains blood flow constant despite changes in blood pressure (BP). Impaired CA may cause overperfusion injury, edema formation and neurological symptoms. We tested the hypothesis that eclampsia is associated with impaired cerebral autoregulation. In a prospective cohort study of recent postpartum patients, we included eclamptic patients studied at < 48 hour after the insult (n=7), and compared them with a normotensive control group (n=10), matched for gestational age (EGA). Eclamptic patients received MgSO4 and anti-hypertensive therapy according to local protocol. Preterm delivery in the control group was due to spontaneous preterm birth or fetal distress. Cerebral blood flow velocity (CBFV) in the middle cerebral artery (transcranial Doppler ultrasound), BP (noninvasive arterial volume clamping), and end-tidal carbon dioxide (EtCO2) were recorded during a 7-minute period of rest. Autoregulation Index (ARI) was determined from the CBFV responses to spontaneous fluctuations in BP. ARI values of 0 and 9 indicate absent and perfect autoregulation, respectively. Cerebral perfusion pressure (CPP) was calculated as previously described. Statistics: student t-test, with P< 0.05 considered significant. Data are presented as mean±SD The groups had similar EGA at delivery (33.6±5.3 vs 34.1±4.4 weeks) and no patients had neurological symptoms at time of recording. ARI was significantly reduced in eclampsia (ARI 4.3±0.7) when compared to controls (7.4±0.5, P< 0.01), while CPP was higher (108±13 vs 82±19 mmHg, P< 0.01). EtCO2 was similar (34.8±1.4 vs 33.8±1.8 mmHg). Women with a recent eclamptic insult have severely impaired CA and increased CPP compared with gestational age-matched normotensive women. Further research should focus on possible modifiable factors to improve CA and on the association between CA and long-term neurological outcome after eclampsia.

Pengaruh Terapi Bekam Kering Terhadap Tekanan Darah Pada Ibu Preeklampsia Postpartum

Preeklampsia selama kehamilan bisa menetap pada masa postpartum dan biasanya akan kembali normal pada minggu pertama postpartum. Angka kejadian preeklampsia atau hipertensi postpartum secara keseluruhan terjadi sekitar 57,1%. Teknik non farmakologis untuk mengatasi hipertensi telah dikembangkan, salah satunya adalah bekam kering sebagai pilihan menurunkan tekanan darah. Penelitian quasy experiment dengan non equivalent control group design. Lokasi penelitian di RSUD Dr. Saiful Anwar Malang. Waktu penelitian dimulai bulan agustus-september 2018. Populasi dalam penelitian ini adalah 34 ibu preeklampsia postpartum dengan kriteria tekanan darah sistolik minimal 140 mmHg dan telah mendapatkan terapi MgSO4 sebelumnya. Sampel penelitian terdiri dari 17 sampel pada kelompok perlakuan dan 17 sampel pada kelompok kontrol. Teknik pengambilan sampel menggunakan consecutive sampling. Variabel independen penelitian ini adalah terapi bekam kering, sedangkan variabel dependen adalah tekanan darah. Uji statistik yang digunakan paired t test dan uji wilcoxon untuk menganalisis perbedaan sebelum dan setelah perlakuan. uji independent sampel t-test dan uji mann whitney untuk menganalisis perbedaan antara kedua kelompok. Hasil uji beda dengan uji wilcoxon didapatkan nilai p-value pada tekanan darah sistolik dan diastolik lebih kecil dari taraf signifikansi α = 0,05, maka dapat disimpulkan bahwa ada perbedaan bermakna tekanan darah ibu preeklampsia postpartum sebelum dan setelah diberikan terapi bekam kering dan terapi standar. Hasil analisis mann whitney diperoleh data bahwa terdapat perbedaan bermakna pada selisih tekanan darah sistolik antara kelompok yang diberi terapi standar dan kelompok yang diberi terapi standar ditambah terapi bekam kering. Berdasarkan hasil penelitian tersebut maka terapi bekam kering bisa digunakan sebagai terapi pendamping untuk menurunkan tekanan darah pada ibu preeklampsia postpartum.

MgSO4 And Slow Stroke Back Massage Therapy On Blood Pressure of Severe Pre Eclampsia Pregnant Women

Preeclampsia is a dangerous complication for pregnant women and their fetuses, this can cause damage to body organs namely heart failure, kidney failure, liver dysfunction, blood clotting disorders, death for the mother and fetus, if not immediately addressed well and correctly. Management of severe preeclampsia by administering MgSO4 intravenously to mothers as prevention of seizures, one of the nursing actions to overcome preeclampsia patients is the provision of relaxation techniques Slow stroke back massage. The objective of this research to determine the effectiveness of MgSO4 Therapy and Slow Stroke Back Massage on Blood Pressure Response In Severe Preeclampsia Pregnant Women at Roemani Hospital Muhammadiyah Semarang. This research uses the quasi-experimental design with the pre and post test perspective. This research measured 32 the pregnant women with severe preeclampsia at Roemani Muhammadiyah Hospital Semarang from purposive sampling technique. The result of this research was shown the effect of blood pressure reduction in all preeclampsia pregnant women given MgSO4 therapy and slow stroke back massage. There is a significant influence on the provision of MgSO4 therapy and slow stroke back massage on the blood pressure response of severe preeclampsia pregnant women.

ROLE OF MAGNESIUM SULPHATE IN NEWBORNS WITH BIRTH ASPHYXIA.

Background; Birth asphyxia is a leading cause of mortality and morbidity in neonates in developing countries, with an incidence of 100-250/1000 live births compared to 5-10/1000 live births in the developed world. It remains a significant cause of loss of life and adverse developmental outcome. Objective; To compare magnesium sulphate therapy versus placebo in control of fits among newborns admitted with birth asphyxia along with fits at a tertiary care hospital. Material and Methods; All the study (n=260) participants of either sex who met inclusion of this study were who are admitted with birth asphyxia. Group A was study group and was treated with magnesium sulfate in a dose of 250 mg/kg initially within six hours of birth followed by 250 mg/kg at 24 and 48 h of birth while group B (control group) was not given MgSO4 therapy and were observed for control of fits and was given standard treatment. Results; Of these 260 study cases, 139 (53.5 %) were male patients while 121 (46.5 %) were female patients. Mean age of our study cases was 3.84 ± 1.47 hours. Of these 260 study cases, 177 (68.1%) belonged to rural areas and 83 (31.9 %) belonged to urban areas. Of these 260 study cases, home delivery was noted in 91 (35.0%), 149 (57.3%) in private clinics / hospital and 20 (7.7%) in teaching hospital. Mean gestational age of our study cases was 38.23 ± 2.38 and preterm births were noted in 91 (35.0%) of our study cases. Of these 260 study cases, control of fits were noted in 173 (66.5%) while control of fits in group A were noted in 105 (80.8%) and in group B it was 68 (52.3%) (p = 0.000). Conclusion; Our study results support the use of Magnesium Sulphate in control of fits in children with birth asphyxia. Magnesium sulphate was safe, reliable and having no side effect so it can be used safely in these patients to reduce morbidity and mortality. All clinicians treating such patients can employ this treatment modality having safety and efficacy. Keywords; Birth asphyxia, Control of fits, Magnesium Sulphate. DOI : 10.7176/JMPB/54-20 Publication date : April 30 th 2019