Antenatal Exposure to Magnesium Sulfate and Spontaneous Intestinal Perforation and Necrotizing Enterocolitis in Extremely Preterm Neonates

Shalabi, Mohamed; Mohamed, Adel; Lemyre, Brigitte; Aziz, Khalid; Faucher, Daniel; Shah, Prakesh S.

doi:10.1055/s-0037-1603344

Cited by 18 publications

(27 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our cohort of 302 neonates with a birth weight ≤1,000 g and/or GA ≤28 weeks, we found no relationship between antenatal MgSO 4 exposure and the individual or combined outcomes of SIP, NEC, or death. This remained true for the subset of neonates < 26 weeks GA. Our results complement data from the studies by the Pediatrix Medical Group [9] and the Canadian Neonatal Network [10]. Similarly, the original randomized controlled trials investigating antenatal MgSO 4 for neuroprotection [3-5] showed no increase in neonatal and pediatric adverse outcomes.…”

Section: Discussionsupporting

confidence: 82%

“…In these two studies MgSO 4 for neuroprotection regimens were in accordance with the NICHD Maternal Fetal Medicine Units Network study [5]. However, two larger reports by the Pediatrix Medical Group and the Canadian Neonatal Network showed no increase in neonatal adverse outcomes in relationship to any antenatal MgSO 4 exposure [9, 10]. …”

Section: Introductionmentioning

confidence: 81%

“…While MgSO 4 infusion protocols vary among institutions in dose, duration, and criteria for reloading, most studies have assessed MgSO 4 exposure in a dichotomous fashion only: exposed or not [7-10]. Moreover, no previous study has reported on the timing of antenatal MgSO 4 exposure in relation to birth or the onset of intestinal injury.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lack of Evidence for Time or Dose Relationship between Antenatal Magnesium Sulfate and Intestinal Injury in Extremely Preterm Neonates

et al. 2019

View full text Add to dashboard Cite

Background: Recent studies reported conflicting results on the relationship between antenatal magnesium sulfate (MgSO₄) exposure and neonatal intestinal injury. Most studies have not assessed MgSO₄ exposure quantitatively and none reported the exposure timing. Objectives: The aim of this work was to assess whether there is a temporal or dose-dependent relationship between antenatal MgSO₄ exposure and intestinal injury in extremely preterm neonates. Methods: A retrospective study was made of inborn neonates with gestational age ≤28 weeks and/or birth weights ≤1,000 g. Primary outcomes included necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), and/or death prior to discharge or in the first 2 weeks of life. Outcome comparisons were made based on the timing of MgSO₄ exposure, within 7 days (Mg7D) or within 3 days (Mg3D) of birth. Total cumulative doses for the Mg3D group were also computed. Results: A total of 302 neonates were included, 210 in the Mg7D group, out of whom 179 (85.2%) constituted the Mg3D group. There were no differences noted when comparing MgSO₄ exposure timing and the likelihood of NEC, SIP, and/or death. This remained the same for subgroup analysis of neonates < 26 weeks’ gestation. Each 10-g increase in MgSO₄ cumulative dose correlated with a decrease in SIP/NEC/death by 18.9% prior to discharge and by 21.9% in the first 2 weeks of life. Small for gestational age (SGA) was a potential effect modifier by a likelihood ratio test with p = 0.07. Conclusions: Antenatal MgSO₄ exposure in extremely preterm neonates was not associated with an increased risk of intestinal injury or death, and might have reduced these complications in a dose-dependent manner in our study. This protective effect was more noticeable in SGA neonates.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 81%

See 1 more Smart Citation

Lack of Evidence for Time or Dose Relationship between Antenatal Magnesium Sulfate and Intestinal Injury in Extremely Preterm Neonates

et al. 2019

View full text Add to dashboard Cite

show abstract

“…69 A large population-based study reported no association between antenatal exposure to magnesium sulfate and necrotizing enterocolitis or spontaneous intestinal perforation in extremely preterm infants after adjustment for confounding variables, including SGA. 70 Guidelines from professional societies recommend that magnesium sulfate administration should be considered for women with imminent preterm birth, although there are variations in the upper limit of GA for which it has been suggested (<32 vs <30 weeks). 56,[71][72][73] Important to the context of this review is that none of the recommendations specify magnesium sulfate administration guidelines when fetal SGA is suspected.…”

Section: Gaps Of Knowledge and Recommendationsmentioning

confidence: 99%

Antenatal glucocorticoids, magnesium sulfate, and mode of birth in preterm fetal small for gestational age

Ting

Kingdom

Shah

2018

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

A diagnosis of fetal growth restriction and subsequent preterm birth is associated with increased risks of adverse perinatal and neurodevelopmental outcomes and potentially long-lasting effects to adulthood. Most such cases are associated with placental insufficiency and the fetal response to chronic intrauterine hypoxemia and nutrient deprivation leads to substantial physiological and metabolic adaptations. The management of such pregnancies, especially with respect to perinatal interventions and birth mode, remains an unresolved dilemma. The benefits from standard interventions for threatened preterm birth may not be necessarily translated to pregnancies with small-for-gestational-age fetuses. Clinical trials or retrospective studies on outcomes following administration of antenatal glucocorticoids and magnesium sulfate for neuroprotection when preterm birth is imminent either have yielded conflicting results for small-for-gestational-age fetuses, or did not include this subgroup of patients. Experimental models highlight potential harmful effects of administration of antenatal glucocorticoids and magnesium sulfate in the pregnancies with fetal small for gestational age although clinical data do not substantiate these concerns. In addition, heterogeneity in definitions of fetal small for gestational age, variations in the inclusion criteria, and the glucocorticoid regime contribute to inconsistent results. In this review, we discuss the physiologic adaptions of the small-for-gestational-age fetus to its abnormal in utero environment in relation to antenatal glucocorticoids; the impact of antenatal glucocorticoids and intrapartum magnesium sulfate in pregnancies with fetal small for gestational age; the current literature on birth mode for pregnancies with fetal small for gestational age; and the knowledge gaps in the existing literature.

show abstract

“…[10] However, the association between antenatal MgSO 4 and morbidities of the gastrointestinal (GI) tract in preterm infants is still controversial in extremely preterm infants. [13] Therefore, our study aims to explore the effects of antenatal MgSO 4 on the neonatal outcomes of preterm infants, including intestinal morbidities requiring surgical interventions.…”

Section: Introductionmentioning

confidence: 99%

Antenatal Magnesium Sulfate Reduced Intestinal Morbidities Requiring Surgery in Preterm Infants With Extremely Low Gestational Age: A Retrospective Cohort Study

Kim¹,

Kim²,

Shin³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Antenatal magnesium sulfate is widely used as a tocolytic, for maternal seizures, and for seizure prophylaxis in preeclampsia. Recent studies have suggested that antenatal magnesium sulfate use is associated with favorable neurodevelopmental outcomes in preterm infants. However, there are concerns regarding the neonatal effects of antenatal magnesium sulfate, especially regarding gastrointestinal morbidities. This study aims to explore the effects of antenatal magnesium sulfate on intestinal morbidities requiring surgery in preterm infants.Methods This was a retrospective cohort study of 181 preterm infants who were born at less than 28 weeks of gestational age. Subjects were categorized as infants exposed to antenatal magnesium sulfate and those not exposed to antenatal magnesium sulfate.Results Antenatal magnesium sulfate was associated with a lower incidence of surgical conditions of the intestine (OR 0.393, 95% CI 0.170–0.905). Multivariate analysis showed that the duration of antenatal magnesium sulfate use was associated with surgical conditions of the intestine (adjusted OR 0.766, 95% CI 0.589–0.997). In the < 26 weeks of gestational age subgroup, use of antenatal magnesium sulfate was significantly associated with decreased intestinal morbidities requiring surgery (adjusted OR 0.234, 95% CI 0.060–0.922).Conclusion Antenatal magnesium sulfate use appears to have a protective effect on intestinal morbidities requiring surgery in preterm infants in a duration-dependent manner. Association of antenatal magnesium sulfate use and decreased intestinal morbidities requiring surgery was more distinct in preterm infants < 26 weeks of gestational age.

show abstract

Antenatal Exposure to Magnesium Sulfate and Spontaneous Intestinal Perforation and Necrotizing Enterocolitis in Extremely Preterm Neonates

Cited by 18 publications

References 30 publications

Lack of Evidence for Time or Dose Relationship between Antenatal Magnesium Sulfate and Intestinal Injury in Extremely Preterm Neonates

Lack of Evidence for Time or Dose Relationship between Antenatal Magnesium Sulfate and Intestinal Injury in Extremely Preterm Neonates

Antenatal glucocorticoids, magnesium sulfate, and mode of birth in preterm fetal small for gestational age

Antenatal Magnesium Sulfate Reduced Intestinal Morbidities Requiring Surgery in Preterm Infants With Extremely Low Gestational Age: A Retrospective Cohort Study

Contact Info

Product

Resources

About