Document Detail


Effects of antenatal exposure to magnesium sulfate on neuroprotection and mortality in preterm infants: a meta-analysis.
MedLine Citation:
PMID:  19622997     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To review the evidence regarding neuroprotective effects of antenatal exposure to magnesium sulfate.
DATA SOURCES: We conducted database searches of MEDLINE, the Cochrane Library and Controlled Trials Register, as well as the ClinicalTrials.gov and International Clinical Trials Register websites. Bibliographies of all relevant articles were reviewed.
METHODS OF STUDY SELECTION: Randomized controlled trials comparing magnesium sulfate with placebo/other treatment in patients at risk of preterm delivery were evaluated for inclusion and methodological quality. The primary outcome was death or cerebral palsy by 18-24 months corrected age. Secondary outcomes were death, cerebral palsy, moderate-severe cerebral palsy, and death or moderate-severe cerebral palsy. Separate analyses were performed according to the gestational age (GA) at randomization (less than 32 to 34 weeks and less than 30 weeks) and for studies in which magnesium sulfate was used exclusively for fetal neuroprotection.
TABULATION, INTEGRATION, AND RESULTS: Five randomized controlled trials were included (5,235 fetuses/infants). When analyzed by GA at randomization, in utero exposure to magnesium sulfate at less than 32-34 weeks did not reduce the rate of death or cerebral palsy (relative risk [RR] 0.92, 95% confidence interval [CI] 0.83-1.03). However, cerebral palsy (RR 0.70, 95% CI 0.55-0.89), moderate-severe cerebral palsy (RR 0.60, 95% CI 0.43-0.84), and death or moderate-severe cerebral palsy were significantly reduced, without an evident increase in the risk of death (RR 1.01, 95% CI 0.89-1.14). Similar results were obtained when the GA at randomization was less than 30 weeks. When only neuroprotection trials (four trials, 4,324 fetuses/infants) are analyzed, in utero exposure to magnesium sulfate additionally reduced the primary outcome of death or cerebral palsy. The number needed to treat to prevent one case of cerebral palsy among those who survive until age 18-24 months is 46 (95% CI 26-187) in infants exposed to magnesium sulfate in utero before 30 weeks, and 56 (95% CI 34-164) in infants exposed to magnesium sulfate in utero before 32 to 34 weeks.
CONCLUSION: Fetal exposure to magnesium sulfate in women at risk of preterm delivery significantly reduces the risk of cerebral palsy without increasing the risk of death.
Authors:
Maged M Costantine; Steven J Weiner;
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  114     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-22     Completed Date:  2009-09-25     Revised Date:  2013-08-30    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  354-64     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, USA. mmcostan@utmb.edu
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MeSH Terms
Descriptor/Qualifier:
Cerebral Palsy / prevention & control*
Female
Fetus / drug effects*
Gestational Age
Humans
Infant, Newborn
Infant, Premature*
Magnesium Sulfate / pharmacology*
Mortality
Pregnancy
Randomized Controlled Trials as Topic
Tocolytic Agents / pharmacology
Grant Support
ID/Acronym/Agency:
HD19897/HD/NICHD NIH HHS; HD21410/HD/NICHD NIH HHS; HD21414/HD/NICHD NIH HHS; HD27860/HD/NICHD NIH HHS; HD27861/HD/NICHD NIH HHS; HD27869/HD/NICHD NIH HHS; HD27905/HD/NICHD NIH HHS; HD27915/HD/NICHD NIH HHS; HD27917/HD/NICHD NIH HHS; HD34116/HD/NICHD NIH HHS; HD34122/HD/NICHD NIH HHS; HD34136/HD/NICHD NIH HHS; HD34208/HD/NICHD NIH HHS; HD34210/HD/NICHD NIH HHS; HD36801/HD/NICHD NIH HHS; HD40485/HD/NICHD NIH HHS; HD40500/HD/NICHD NIH HHS; HD40512/HD/NICHD NIH HHS; HD40544/HD/NICHD NIH HHS; HD40545/HD/NICHD NIH HHS; HD40560/HD/NICHD NIH HHS; HD53907/HD/NICHD NIH HHS; M01 RR000080-447986/RR/NCRR NIH HHS; R24 HD050924-07/HD/NICHD NIH HHS; U10 HD021410-24/HD/NICHD NIH HHS; U10 HD021414-15/HD/NICHD NIH HHS; U10 HD027860-11/HD/NICHD NIH HHS; U10 HD027861-10S2/HD/NICHD NIH HHS; U10 HD027869/HD/NICHD NIH HHS; U10 HD027869-19/HD/NICHD NIH HHS; U10 HD027905-09/HD/NICHD NIH HHS; U10 HD027915-18/HD/NICHD NIH HHS; U10 HD027917-19/HD/NICHD NIH HHS; U10 HD034116-14/HD/NICHD NIH HHS; U10 HD034122-05/HD/NICHD NIH HHS; U10 HD034136-07/HD/NICHD NIH HHS; U10 HD034208-14/HD/NICHD NIH HHS; U10 HD034210-05/HD/NICHD NIH HHS; U10 HD036801/HD/NICHD NIH HHS; U10 HD036801-11S1/HD/NICHD NIH HHS; U10 HD040485-03/HD/NICHD NIH HHS; U10 HD040500-07/HD/NICHD NIH HHS; U10 HD040512-09/HD/NICHD NIH HHS; U10 HD040544-09/HD/NICHD NIH HHS; U10 HD040545-06/HD/NICHD NIH HHS; U10 HD040560-09/HD/NICHD NIH HHS; U10 HD053097/HD/NICHD NIH HHS; U10 HD053097-04/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Tocolytic Agents; 7487-88-9/Magnesium Sulfate
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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