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ADC-FNN Online First, published on April 20, 2015 as 10.1136/archdischild-2014-307655 Review
Antenatal magnesium sulfate: Neuro-protection for preterm infants S Oddie,1,2,3,4 D J Tuffnell,2,5 W McGuire3,4,6 1
Bradford Neonatology, Bradford Royal Infirmary, West Yorkshire, UK 2 Bradford Institute for Health Research 3 Hull York Medical School 4 Centre for Reviews and Dissemination, University of York, York, UK 5 Maternity Unit, Bradford Royal Infirmary, West Yorkshire, UK 6 Department of Paediatrics, York Teaching Hospital Correspondence to Dr Sam Oddie, Bradford Neonatology, Bradford Royal Infirmary, West Yorkshire BD9 6RJ, UK; Sam.Oddie@bthft. nhs.uk Received 28 January 2015 Revised 25 March 2015 Accepted 29 March 2015
ABSTRACT The neuro-protective effect of antenatal magnesium sulfate on very preterm infants has been demonstrated in good-quality randomised controlled trials and metaanalyses. Magnesium administered prior to preterm delivery crosses over to the foetal circulation and acts via several pathways to reduce perinatal neuronal damage. Meta-analysis of the trial data indicates that antenatal magnesium sulfate reduces the risk of cerebral palsy by one-third, and results in one fewer case in every 50 women treated. Treatment is associated with discomfort and flushing in some women, but maternal side-effects are mostly transient and manageable. Magnesium sulfate has also been found to be without any serious adverse consequences in newborn infants. Consensus recommendations and guidelines have been developed and implemented internationally, and endorsed by the UK Royal College of Obstetricians and Gynaecologists. However, magnesium sulfate for neuro-protection of very preterm infants has not yet become established widely in UK practice. Paediatricians, neonatologists and advocacy groups for preterm infants and their families could contribute to raising awareness and engage in dissemination activities and implementation initiatives to develop local protocols for adoption of this safe, effective and cost-effective intervention to reduce the burden of cerebral palsy in children born very preterm. Over the past five decades, the development and adoption of key evidence-based care practices and interventions have improved important outcomes for preterm infants substantially. In particular, the use of antenatal corticosteroids and postnatal surfactant replacement has reduced dramatically early mortality due to respiratory failure in very preterm (
ADC-FNN Online First, published on April 20, 2015 as 10.1136/archdischild-2014-307655 Review
Antenatal magnesium sulfate: Neuro-protection for preterm infants S Oddie,1,2,3,4 D J Tuffnell,2,5 W McGuire3,4,6 1
Bradford Neonatology, Bradford Royal Infirmary, West Yorkshire, UK 2 Bradford Institute for Health Research 3 Hull York Medical School 4 Centre for Reviews and Dissemination, University of York, York, UK 5 Maternity Unit, Bradford Royal Infirmary, West Yorkshire, UK 6 Department of Paediatrics, York Teaching Hospital Correspondence to Dr Sam Oddie, Bradford Neonatology, Bradford Royal Infirmary, West Yorkshire BD9 6RJ, UK; Sam.Oddie@bthft. nhs.uk Received 28 January 2015 Revised 25 March 2015 Accepted 29 March 2015
ABSTRACT The neuro-protective effect of antenatal magnesium sulfate on very preterm infants has been demonstrated in good-quality randomised controlled trials and metaanalyses. Magnesium administered prior to preterm delivery crosses over to the foetal circulation and acts via several pathways to reduce perinatal neuronal damage. Meta-analysis of the trial data indicates that antenatal magnesium sulfate reduces the risk of cerebral palsy by one-third, and results in one fewer case in every 50 women treated. Treatment is associated with discomfort and flushing in some women, but maternal side-effects are mostly transient and manageable. Magnesium sulfate has also been found to be without any serious adverse consequences in newborn infants. Consensus recommendations and guidelines have been developed and implemented internationally, and endorsed by the UK Royal College of Obstetricians and Gynaecologists. However, magnesium sulfate for neuro-protection of very preterm infants has not yet become established widely in UK practice. Paediatricians, neonatologists and advocacy groups for preterm infants and their families could contribute to raising awareness and engage in dissemination activities and implementation initiatives to develop local protocols for adoption of this safe, effective and cost-effective intervention to reduce the burden of cerebral palsy in children born very preterm. Over the past five decades, the development and adoption of key evidence-based care practices and interventions have improved important outcomes for preterm infants substantially. In particular, the use of antenatal corticosteroids and postnatal surfactant replacement has reduced dramatically early mortality due to respiratory failure in very preterm (
