Magnesium sulphate for women at term for neuroprotection of the fetus

Nguyen, T.; Crowther, Caroline A; Wilkinson, Dominic; Bain, Emily

doi:10.1002/14651858.cd009395.pub2

Cited by 26 publications

(10 citation statements)

References 39 publications

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“…Maternal treatment using MgSO 4 was able to reduce the risk of cerebral palsy and gross motor dysfunction in newborns at risk of preterm birth (Doyle et al, 2010;Shepherd et al, 2017). In contrast, there are no conclusive evidence regarding its efficacy or safety in term newborns (Nguyen et al, 2013). Preclinical evidence suggests that calcium influx blockage via NMDA receptor, thus reducing excitotoxic damage, is the neuroprotective mechanism attributed to MgSO 4 (Zeevalk et al, 1992).…”

Section: Drugs Used During Gestation: Glucocorticoids Oxytocin and Mmentioning

confidence: 99%

Pregnancy as a valuable period for preventing hypoxia‐ischemia brain damage

Netto

Sanches

Odorcyk

et al. 2018

Intl J of Devlp Neuroscience

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Neonatal brain Hypoxia-Ischemia (HI) is one of the major causes of infant mortality and lifelong neurological disabilities. The knowledge about the physiopathological mechanisms involved in HI lesion have increased in recent years, however these findings have not been translated into clinical practice. Current therapeutic approaches remain limited; hypothermia, used only in term or near-term infants, is the golden standard. Epidemiological evidence shows a link between adverse prenatal conditions and increased risk for diseases, health problems, and psychological outcomes later in life, what makes pregnancy a relevant period for preventing future brain injury. Here, we review experimental literature regarding preventive interventions used during pregnancy, i.e., previous to the HI injury, encompassing pharmacological, nutritional and/or behavioral strategies. Literature review used PubMed database. A total of forty one studies reported protective properties of maternal treatments preventing perinatal hypoxia-ischemia injury in rodents. Pharmacological agents and dietary supplementation showed mainly anti-excitotoxicity, anti-oxidant or anti-apoptotic properties. Interestingly, maternal preconditioning, physical exercise and environmental enrichment seem to engage the same referred mechanisms in order to protect neonatal brain against injury. This construct must be challenged by further studies to clearly define the main mechanisms responsible for neuroprotection to be explored in experimental context, as well as to test their potential in clinical settings.

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Section: Drugs Used During Gestation: Glucocorticoids Oxytocin and Mmentioning

confidence: 99%

Pregnancy as a valuable period for preventing hypoxia‐ischemia brain damage

Netto

Sanches

Odorcyk

et al. 2018

Intl J of Devlp Neuroscience

View full text Add to dashboard Cite

show abstract

“…Following the Cochrane meta-analysis review,51 MG became “the drug of choice” for preventing brain injuries and cerebral palsy in “at-risk” fetuses. In light of the importance of preventing newborn brain injury, and although the neuroprotective mechanism of MG has not been elucidated, we sought to investigate the use of MG in preventing short- and long-term fetal brain consequences of LPS-induced maternal inflammation.…”

Section: Therapeutic Strategies Of Neuroprotectionmentioning

confidence: 99%

Maternal Inflammation, Fetal Brain Implications and Suggested Neuroprotection: A Summary of 10 Years of Research in Animal Models

Ginsberg¹,

Khatib²,

Weiner³

et al. 2017

Rambam Maimonides Med J

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A growing body of evidence implies that maternal inflammation during pregnancy is associated with increased risk of neurodevelopmental disorders in the offspring. The pathophysiological mechanisms by which maternal inflammation evokes fetal brain injury and contributes to long-term adverse neurological outcomes are not completely understood. In this review, we summarize 10 years of our research experience on maternal inflammation and the implications upon the fetal/offspring brain. We review our findings regarding the underlying mechanisms that connects maternal inflammation and fetal brain injuries (e.g. cytokines, oxidative stress); we discuss our imaging, pathological and behavioral test results which support brain damage following maternal inflammation; and finally we describe some of the therapeutic strategies which might prevent the damage.

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“…Por último, es necesario tener presente si la madre ha recibido tratamiento con sulfato de magnesio previo al parto (25). En el 30% de los RN prematuros cuyas madres recibieron este tratamiento se han encontrado cifras de magnesio sérico > 3,5 mg/dl en el primer día de vida (26).…”

Section: Requerimientos De Minerales Y Oligoelementosunclassified

Nutrición parenteral en situaciones clínicas especiales

Martínez¹,

Giner

2017

Nutr Hosp

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RECIÉN NACIDO PREMATUROLa nutrición parenteral (NP) constituye un pilar fundamental en la nutrición del recién nacido (RN) prematuro, especialmente en el RN muy prematuro (< 32 semanas de gestación) y RN prematuro extremo (< 28 semanas de gestación) (1). En estos pacientes, la administración de una NP balanceada y precoz se considera de elección (2). Dos metaanálisis han demostrado que la NP precoz en el RN prematuro < 1.500 g es segura, sin aumentar el riesgo de efectos adversos (3,4), y ha mostrado beneficios en relación con un balance nitrogenado positivo (ver aporte proteico) y mayor ganancia ponderal respecto a controles, aunque no se ha observado mayor longitud o perímetro craneal al alta en el grupo de intervención (3). Cabe destacar que los ensayos clínicos analizados cuentan con pequeño tamaño muestral y son heterogéneos (3,4). NECESIDADES ENERGÉTICASLa evidencia sobre las necesidades energéticas del RN prematuro es muy escasa, pues desde una aproximación empírica es muy difícil desligar el efecto de la energía administrada del obtenido por el aporte proteico y resto de nutrientes. Por tanto, las recomendaciones energéticas del RN prematuro se basan en el método factorial, asumiendo que su composición corporal es similar a la del feto y que el crecimiento debería ser similar al que ocurre intraútero (5). Actualmente, se recomienda un aporte inicial de 60 kcal/kg/día, con aumento rápido y progresivo hasta las 90-100 kcal/kg/día en la primera semana (1). Posteriormente se irá incrementado en función del peso de RN (2,6), con el objetivo de conseguir un crecimiento lo más próximo al crecimiento fetal (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" en las tablas II y III). MODIFICACIONES EN EL DISEÑO DEL PREPARADO DE NP Requerimientos proteicosEl aporte proteico mínimo para conseguir un balance nitrogenado positivo en el RN prematuro es 1,5 g/kg/día (6). No obstante, en los últimos años se ha demostrado seguro el aporte inicial de 2,4 g/kg/ día el primer día de vida (4,7,8). Los resultados dependen no solo de la dosis de aminoácidos (AA) sino del aporte concomitante de calorías no proteicas. Así, en el RN prematuro < 1.500 g el aporte proteico inicial de 2,4 g/kg/día junto a lípidos (2 g/kg/día el primer día, incrementando a 3 g/kg/día el segundo) mejoró el balance nitrogenado respecto al mismo aporte proteico sin lípidos (7). Aportes iniciales superiores (3,6 g/kg/día junto a lípidos) no han demostrado mejorar el balance nitrogenado y se asocian a aumento de urea plasmática que refleja una mayor oxidación de AA (7,9). En un reciente ensayo clínico con RN prematuros < 1.500 g se demostró mayor síntesis de albúmina en 12 pacientes con aporte precoz proteico de 3,6 g/ kg/día junto a lípidos comparados con 9 pacientes que recibieron 2,4 g/kg/día junto a lípidos (8), datos que deben ser refrendados en estudios de mayor tamaño muestral (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" para incrementos posteriores).La fórmula de AA a administrar debe contener cisteína, tiro...

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Magnesium sulphate for women at term for neuroprotection of the fetus

Abstract: Witlin 1997 {published data only}Witlin AG, Friedman SA, Sibai BM. The effect of magnesium sulfate therapy on the duration of labor in women with mild preeclampsia at term: A randomised, double-blind, placebo-controlled trial.

Cited by 26 publications

References 39 publications

Pregnancy as a valuable period for preventing hypoxia‐ischemia brain damage

Pregnancy as a valuable period for preventing hypoxia‐ischemia brain damage

Maternal Inflammation, Fetal Brain Implications and Suggested Neuroprotection: A Summary of 10 Years of Research in Animal Models

Nutrición parenteral en situaciones clínicas especiales

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