Effects of antenatal magnesium sulfate use for neuroprotection on cardiorespiratory complications during the early neonatal period in preterm infants

Year 2021, Volume: 5 Issue: 9, 843 - 847, 01.09.2021

Nuran Üstün , Meryem Hocaoğlu , Abdulkadir Turgut , Fahri Ovalı

https://doi.org/10.28982/josam.974461

Abstract

Background/Aim: Antenatal magnesium sulfate (MgSO4) treatment is widely used for fetal neuroprotection in women at risk of preterm delivery. Possible adverse effects of MgSO4 include respiratory depression and delay in closure of ductus arteriosus by antagonism of calcium channels. The aim of this study was to investigate the effects of antenatal MgSO4 exposure on cardiorespiratory complications during the early neonatal period in premature infants.
Methods: A retrospective cohort study was performed on 340 preterm infants born between 23 and 32 weeks of gestational age. Patients were divided into two groups according to antenatal MgSO4 exposure: The MgSO4 group (n=186) and the no-MgSO4 group (n=154). Outcomes were acute cardiorespiratory events (intubation at birth, respiratory support, and hypotension in first day of life), and hemodynamically significant patent ductus arteriosus (HsPDA).
Results: Mothers in the MgSO4 group were more likely to have preeclampsia and antenatal steroid treatment, while their infants were younger in gestation and weighed less (P<0.05). Multivariate regression analysis showed that antenatal MgSO4 exposure was significantly associated with decreased mechanical ventilation (odds ratio [OR] 0.45 95% confidence interval [CI] 0.25-0.81, P=0.008), hypotension (OR 0.47, 95% CI 0.24-0.90, P=0.023) and HsPDA (OR 0.52, 95% CI 0.28-0.97, P=0.039). There was no significant association between antenatal MgSO4 exposure and intubation at birth (OR 1.06 95% CI 0.62-1.82, P=0.828).
Conclusion: Among the preterm infants ≤ 32 weeks, antenatal MgSO4 was not associated with increased risk for acute cardiorespiratory events during the early neonatal period. It might have a protective role in helping with ductal closure.

Keywords

Antenatal magnesium sulfate, Neonatal resuscitation, Patent ductus arterisus, Preterm infants, Neuroprotection

References

• 1. Kruse M, Michelsen S, Flachs EM, Brønnum-Hansen H, Madsen M, Uldall P. Lifetime costs of cerebral palsy. Dev Med Child Neurol. 2009;51(8):622–8. doi: 10.1111/j.1469-8749.2008.03190.x.
• 2. Paneth N, Hong T, Korzeniewski S. The descriptive epidemiology of cerebral palsy. Clin Perinatol. 2006;33(2):251–67. doi: 10.1016/j.clp.2006.03.011.
• 3. Duley L, Gulmezoglu AM, Chou D. Magnesium sulphate versus lytic cocktail for eclampsia. Cochrane Database Syst Rev 2010;2010(9):CD002960. doi: 10.1002/14651858.CD002960.pub2.
• 4. Crowther CA, Hiller JE, Doyle LW, Haslam RR; Australasian Collaborative Trial of Magnesium Sulphate (ACTOMg SO4) Collaborative Group. Effect of magnesium sulfate given for neuroprotection before pretermbirth: a randomized controlled trial. JAMA 2003; 290(20):2669–76. doi: 10.1001/jama.290.20.2669
• 5. Rouse DJ, Hirtz DG, Thom E, Varner MW, Spong CY, Mercer BM, et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008;359 (9):895–905. doi: 10.1056/NEJMoa0801187.
• 6. Marret S,Marpeau L, Follet-Bouhamed C, Cambonie G, Astruc D, Delaporte B, et al; le groupe PREMAG. Effect of magnesium sulphate on mortality and neurologic morbidity of the very-preterm newborn (of less than 33 weeks) with two-year neurological outcome: results of the prospective PREMAG trial. Gynecol Obstet Fertil 2008;36(3):278–288. doi: 10.1016/j.gyobfe.2008.01.012.
• 7. Shepherd E, Salam RA, Middleton P, Makrides M, McIntyre S, Badawi N, et al. Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2017;8(8):CD012077. doi: 10.1002/14651858.CD012077.pub2
• 8. Committee Opinion No. 455: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol. 2010;115(3):669-671. doi: 10.1097/AOG.0b013e3181d4ffa5.
• 9. Narasimhulu D, Brown A, Egbert NM, Rojas M, Haberman S, Bhutada A, et al. Maternal magnesium therapy, neonatal serum magnesium concentration and immediate neonatal outcomes. J Perinatol. 2017;37(12):1297-1303. doi: 10.1038/jp.2017.132
• 10. Mittendorf R, Dambrosia J, Pryde PG, Lee KS, Gianopoulos JG, Besinger RE, et al. Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants. Am J Obstet Gynecol. 2002;186 (6):1111-8. doi: 10.1067/mob.[phone].
• 11. Abbassi-Ghanavati M, Alexander JM, McIntire DD, Savani RC, Leveno KJ. Neonatal effects of magnesium sulfate given to the mother. Am J Perinatol 2012;29(10):795-9. doi: 10.1055/s-0032-1316440.
• 12. del Moral T, Gonzalez-Quintero VH, Claure N, Vanbuskirk S, Bancalari E. Antenatal exposure to magnesium sulfate and the incidence of patent ductus arteriosus in extremely low birth weight infants. J Perinatol 2007;27(3):154-7. doi: 10.1038/sj.jp.7211663.
• 13. Katayama Y, Minami H, Enomoto M, Takano T, Hayashi S, Lee YK. Antenatal magnesium sulfate and the postnatal response of the ductus arteriosus to indomethacin in extremely preterm neonates. J Perinatol. 2011;31(1):21-4. doi: 10.1038/jp.2010.62.
• 14. De Jesus LC, Sood BG, Shankaran S, Kendrick D, Das A, Bell EF, et al. ; Eunice Kennedy Shriver National Institute of Health and Human Development Neonatal Research Network. Antenatal magnesium sulfate exposure and acute cardiorespiratory events in preterm infants. Am J Obstet Gynecol. 2015;212(1):94.e1-7. doi: 10.1016/j.ajog.2014.07.023
• 15. Qasim A, Jain SK, Aly AM. Antenatal Magnesium Sulfate Exposure and Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants. AJP Rep. 2019;9(4):e353-e356. doi: 10.1055/s-0039-3400316.
• 16. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 2007;18(6):805-35
• 17. Kliegman RM, Walsh MC. Neonatal necrotizing enterocolitis: pathogenesis, classification, and spectrum of disease. Curr Probl Pediatr Adolesc Health Care 1987;7(4):213-88. doi: 10.1016/0045-9380(87)90031-4.
• 18. Walsh MC, Wilson-Costello D, Zadell A, Newman N, Fanaroff A. Safety, reliability, and validity of a physiologic definition of bronchopulmonary dysplasia. J Perinatol 2003;23(6):451-6. doi: 10.1038/sj.jp.7210963.
• 19. Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123(7):991-9. doi: 10.1001/archopht.123.7.991.
• 20. Köksal N, Aygün C, Uras N. Türk Neonatoloji Derneği. Prematüre Bebekte Patent Duktus Arteriosus’a Yaklaşim Rehberi 2016.
• 21. Lipsitz PJ, English IC. Hypermagnesemia in the newborn infant.Pediatrics 1967;40(5):856–862
• 22. Rasch DK, Huber PA, Richardson CJ, L’Hommedieu CS, Nelson TE, Reddi R. Neurobehavioral effects of neonatal hypermagnesemia. J Pediatr 1982;100(2):272-6. doi: 10.1016/s0022-3476(82)80654-9.
• 23. Johnson LH, Mapp DC, Rouse DJ, Spong CY, Mercer BM, Leveno KJ, et al. Association of cord blood magnesium concentration and neonatal resuscitation. J Pediatr 2012;160(4):573-577.e1. doi: 10.1016/j.jpeds.2011.09.016.
• 24. Özlü F, Hacıoğlu C, Büyükkurt S, Yapıcıoğlu H, Satar, M . Changes on preterm morbidities with antenatal magnesium. Cukurova Medical Journal 2019;44:502-508
• 25. Bancalari E, Claure N. Strategies to accelerate weaning from respiratory support. Early Hum Dev 2013;89 Suppl 1:S4-6. doi: 10.1016/S0378-3782(13)70002-1
• 26. Vendettuoli V, Bellu R, Zanini R, Mosca F, Gagliardi L; for the Italian Neonatal Network. Changes in ventilator strategies and outcomes in preterm infants. Arch Dis Child Fetal Neonatal Ed 2014;99(4):F321-4. doi: 10.1136/archdischild-2013-305165
• 27. Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017;3(3):CD004454. doi: 10.1002/14651858.CD004454.pub3.
• 28. Osborn DA, Evans N, Kluckow M. Hemodynamic and antecedent risk factors of early and late periventricular/intraventricular hemorrhage in premature infants. Pediatrics 2003;112(1 Pt 1):33-9. doi: 10.1542/peds.112.1.33
• 29. Demarini S, Dollberg S, Hoath SB, Ho M, Donovan EF. Effects of antenatal corticosteroids on blood pressure in very low birth weight infants during the first 24 hours of life. J Perinatol 1999;19(6 Pt 1):419-25. doi: 10.1038/sj.jp.7200245.
• 30. Satake K, Lee JD, Shimizu H, Uzui H, Mitsuke Y, Yue H, et al. Effects of magnesium on prostacyclin synthesis and intracellular free calcium concentration in vascular cells. Magnes Res 2004;17(1):20-27
• 31. Paradisis M, Osborn DA, Evans N, Kluckow M. Randomized controlled trial of magnesium sulfate in women at risk of preterm delivery-neonatal cardiovascular effects. J Perinatol 2012;32(9):665-70. doi: 10.1038/jp.2011.168.
• 32. McPherson JA, Rouse DJ, Grobman WA, Palatnik A, Stamilio DM. Association of duration of neuroprotective magnesium sulfate infusion with neonatal and maternal outcomes. Obstet Gynecol. 2014;124(4):749-755. doi: 10.1097/AOG.0000000000000467
• 33. Ohhashi M, Yoshitomi T, Sumiyoshi K, Kawagoe Y, Satoh S, Sameshima H, et al. Magnesium sulphate and perinatal mortality and morbidity in very-low birth weight infants born between 24 and 32 weeks of gestation in Japan. Eur J Obstet Gynecol Reprod Biol 2016;201:140-5. doi: 10.1016/j.ejogrb.2016.03.048.