Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants

Mittendorf, Robert; Dambrosia, James; Pryde, Peter G.; Lee, Kwang Sun; Gianopoulos, John G.; Besinger, Richard E.; Tomich, Paul G.

doi:10.1067/mob.2002.123544

Cited by 247 publications

(189 citation statements)

References 23 publications

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“…Magnesium sulfate tocolysis has been associated with various neonatal morbidities and mortality. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] The specific association of PIE with increased mortality in ELBW infants was not previously documented. Preterm labor is associated with elevated concentrations of fetal proinflammatory cytokines and other mediators.…”

Section: Discussionmentioning

confidence: 99%

“…27 The data regarding antenatal MgSO 4 and IVH is not entirely conclusive even though Mittendorf found a higher incidence of IVH with magnesium tocolysis in infants <34 weeks of gestation. 11 In a large study involving 1409 infants the relative risk of IVH with maternal receipt of MgSO 4 was 1 (CI 0.7-1.3). The multivariate analysis using a model that controlled the significant covariates yielded a strong Odds ratio for the dosespecific relationship between MgSO 4 and PIE in our study.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants

2006

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Objective: We studied the ante-and postnatal risk factors and clinical outcomes associated with pulmonary interstitial emphysema (PIE) in extremely low birth weight infants (ELBW, <1000 g at birth) in the present era of tocolytics, antenatal steroid and postnatal surfactant administration. Study design:This was a retrospective case-controlled study of all ELBW admitted consecutively during a designated study-period in a level III nursery. Data were analyzed by performing univariate and multivariate analysis as applicable.Results: Infants with PIE had lower 1 and 5 min Apgar scores (P ¼ 0.04 and 0.003 respectively), increased surfactant utilization (P ¼ 0.004), higher maximum inspired oxygen concentration (P ¼ 0.04) and mean airway pressure administration (P ¼ 0.02) during the first week of life, and increased neonatal mortality (P ¼ 0.01). They received higher antenatal doses of magnesium sulfate (MgSO 4 ) (P ¼ 0.02). 56% of infants with PIE were exposed to more than 10 g of MgSO 4 (Mg10), compared to 15% in non-PIE group (P ¼ 0.01). The multivariate logistic regression analysis including significant co-variates revealed an independent association between Mg10 and PIE (P ¼ 0.01, Odds ratio 19.8, 95% CI 1.5-263).Conclusion: Pulmonary interstitial emphysema is associated with increased mortality in ELBW infants. Mg10 is an independent risk factor for PIE in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants

2006

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“…The trial was suspended after 15 months of enrollment because of excess pediatric mortality among those exposed to magnesium sulfate compared to those assigned to other tocolytics (AR ¼ 15.2, 95% CI ¼ 4.8 to 25.6). 5,6,17 A random-effects model meta-analysis combining data from this study with one by Cox et al 18 showed a statistically significant association between tocolytic magnesium and total pediatric death (AR ¼ 10.7, 95% CI ¼ 3.9 to 17.6). 2 In addition to these studies, others have demonstrated an association of magnesium exposure with adverse infant outcome.…”

Section: Discussionmentioning

confidence: 60%

“…In infants whose mothers were treated with magnesium sulfate, significantly elevated levels of magnesium have been measured in the infant's cord blood at delivery. 17 Hypermagnesemia is a well-known cause of neonatal lethargy, hypotonia, and respiratory depression. 5 This diminished respiratory drive could explain the increased risk for respiratory distress and need for endotracheal intubation seen in the tocolytic-exposed infants in our study.…”

Section: Discussionmentioning

confidence: 99%

Hospitalization and Infant Outcomes among Women Exposed and Unexposed to Tocolysis

2004

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OBJECTIVE:To examine whether infants exposed to tocolytics are at increased risk for selected adverse clinical and hospitalization outcomes. STUDY DESIGN:We conducted a population-based cohort study of women with preterm labor, in Washington State from 1989 to 2001 (N ¼ 79,679), using linked hospitalization records. Relative risks for infant outcomes were estimated using multivariate logistic regression. RESULTS:Adjusted risk estimates for infants exposed to tocolysis were greater for respiratory distress (RR ¼ 1.5, 95% CI 1.4 to 1.6), intubation (RR ¼ 1.4, 95% CI 1.2 to 1.5), and bacterial infection (RR ¼ 1.6, 95% CI 1.4 to 1.8). Exposed infants were also more likely to have birth hospitalizations >2 days (RR ¼ 1.4, 95% CI 1.3 to 1.4), require transfer (RR ¼ 1.5, 95% CI 1.3 to 1.8), have increased hospital costs (RR ¼ 2.3, 95% CI 2.2 to 2.4), and require readmisssion within the first year of life (RR ¼ 1.2, 95% CI 1.1 to 1.3). CONCLUSION:Infants exposed to tocolytics appeared to have relatively poorer hospitalization and clinical outcomes; significant benefits were not observed.

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“…4 Owing to the growing evidence suggestive of an association between LSV and two of these adverse outcomes, we are currently investigating whether magnesium sulfate (in the oftenextraordinary dosages used for tocolysis) may be associated with the LSV lesion as well.…”

Section: Dear Editormentioning

confidence: 99%

Identification of Isolated Lenticulostriate Vasculopathy in Preterm Infants

Mittendorf

Roizen

2004

J Perinatol

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Association between the use of antenatal magnesium sulfate in preterm labor and adverse health outcomes in infants

Cited by 247 publications

References 23 publications

Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants

Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants

Hospitalization and Infant Outcomes among Women Exposed and Unexposed to Tocolysis

Identification of Isolated Lenticulostriate Vasculopathy in Preterm Infants

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