Magnesium sulphate given before very‐preterm birth to protect infant brain: the randomised controlled PREMAG trial*

Marret, Stéphane; Marpeau, L.; Zupan-Simunek, V.; Eurin, D.; Lévêque, C.; Hellot, Marie‐France; Bénichou, Jacques

doi:10.1111/j.1471-0528.2006.01162.x

Cited by 256 publications

(217 citation statements)

References 43 publications

Supporting

Mentioning

172

Contrasting

Unclassified

Order By: Relevance

“…Antenatal magnesium sulphate has not been associated with a decrease in central nervous system pathology associated with CP, cognitive impairment (i.e., intraventricular hemorrhage or white matter injury measured as cystic periventricular leukomalacia), and other adverse developmental outcomes associated with preterm birth (e.g., developmental delay, neurological impairment, blindness, or deafness). However, confidence intervals in these trials [35][36][37][38] were reasonably wide and compatible with any of the following: a protective effect (38% reduction), harmful effect (13% increase), or no effect at all. Further evidence is needed to determine whether there is an association between magnesium sulphate and decreased CNS pathology.…”

Section: Summary Statementsupporting

confidence: 55%

“…[32][33][34] Four trials used magnesium sulphate specifically for fetal neuroprotection among women likely to deliver within 24 hours. [35][36][37][38] The fifth trial 26 evaluated the effectiveness of magnesium sulphate for eclampsia prevention in women with preeclampsia. Of the 4 trials with neuroprotective intent, one also included a tocolytic arm.…”

Section: Magnesium Sulphate For Neuroprotectionmentioning

confidence: 99%

“…Of the 4 trials with neuroprotective intent, one also included a tocolytic arm. 37 Three of these 4 trials enrolled primarily women with preterm labour (with or without PPROM), [35][36][37] whereas the fourth focused on women with PPROM. 38 Children were followed-up to the age of 2 years for CP assessment, and 3 trials undertook cognitive testing.…”

Section: Magnesium Sulphate For Neuroprotectionmentioning

confidence: 99%

“…32 Importantly, 4 of the 5 trials (and all neuroprotective intent trials) described an adequate (but subgroup analyses were possible for lower gestational age categories) method of allocation concealment. 26,35,36,38 All but the tocolytic arm of Mittendorf et al 37 described doublemasking of outcome assessment.…”

Section: Magnesium Sulphate For Neuroprotectionmentioning

confidence: 99%

See 3 more Smart Citations

RETIRED: Magnesium Sulphate for Fetal Neuroprotection

Magee

Sawchuck

Synnes

et al. 2011

Journal of Obstetrics and Gynaecology Canada

110

View full text Add to dashboard Cite

This document reflects emerging clinical and scientific advances on the date issued, and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC. AbstractObjective: To provide guidelines for the use of antenatal magnesium sulphate (MgSO 4 ) for fetal neuroprotection of the preterm infant .Options: Antenatal MgSO 4 administration should be considered for fetal neuroprotection when women present at ≤ 31+6 weeks with imminent preterm birth, defined as a high likelihood of birth because of active labour with cervical dilatation ≥ 4 cm, with or without preterm pre-labour rupture of membranes, and/or planned preterm birth for fetal or maternal indications .There are no other known fetal neuroprotective agents .Outcomes: The outcomes measured are the incidence of cerebral palsy (CP) and neonatal death . Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1) .Benefits, harms, and costs: Antenatal magnesium sulphate for fetal neuroprotection reduces the risk of "death or CP" (RR 0 .85; 95% CI 0 .74 to 0 .98; 4 trials, 4446 infants), "death or moderatesevere CP" (RR 0 .85; 95% CI 0 .73 to 0 .99; 3 trials, 4250 infants), "any CP" (RR 0 .71; 95% CI 0 .55 to 0 .91; 4, trials, 4446 infants), "moderate-to-severe CP" (RR 0 .60; 95% CI 0 .43 to 0 .84; 3 trials, 4250 infants), and "substantial gross motor dysfunction" (inability to walk without assistance) (RR 0 .60; 95% CI 0 .43 to 0 .83; 3 trials, 4287 women) at 2 years of age . Results were consistent between trials and across the meta-analyses . There is no anticipated significant increase in health care-related costs, because women eligible to receive antenatal MgSO 4 will be judged to have imminent preterm birth .

show abstract

Section: Summary Statementsupporting

confidence: 55%

Section: Magnesium Sulphate For Neuroprotectionmentioning

confidence: 99%

Section: Magnesium Sulphate For Neuroprotectionmentioning

confidence: 99%

Section: Magnesium Sulphate For Neuroprotectionmentioning

confidence: 99%

See 2 more Smart Citations

RETIRED: Magnesium Sulphate for Fetal Neuroprotection

Magee

Sawchuck

Synnes

et al. 2011

Journal of Obstetrics and Gynaecology Canada

110

View full text Add to dashboard Cite

show abstract

“…165 Improvements in neonatal outcomes that are of potential clinical significance have been demonstrated following magnesium administration to mothers prior to preterm birth. 166 Infusion of magnesium in patients with subarachnoid hemorrhage has been shown to reduce the occurrence of delayed ischemia caused by cerebrovascular spasm. 167 Finally, magnesium administration has been shown to be particularly useful in preserving short-term memory and cortical control over brainstem functions after cardiac surgery.…”

Section: Magnesiummentioning

confidence: 99%

Multifunctional Drugs for Head Injury

2009

View full text Add to dashboard Cite

Summary: Traumatic brain injury (TBI) remains one of the leading causes of mortality and morbidity worldwide in individuals under the age of 45 years, and, despite extensive efforts to develop neuroprotective therapies, there has been no successful outcome in any trial of neuroprotection to date. In addition to recognizing that many TBI clinical trials have not been optimally designed to detect potential efficacy, the failures can be attributed largely to the fact that most of the therapies investigated have been targeted toward an individual injury factor. The contemporary view of TBI is that of a very heterogenous type of injury, one that varies widely in etiology, clinical presentation, severity, and pathophysiology. The mechanisms involved in neuronal cell death after TBI involve an interaction of acute and delayed anatomic, molecular, biochemical, and physiological events that are both complex and multifaceted. Accordingly, neuropharmacotherapies need to be targeted at the multiple injury factors that contribute to the secondary injury cascade, and, in so doing, maximize the likelihood of a successful outcome. This review focuses on a number of such multifunctional compounds that have shown considerable success in experimental studies and that show maximum promise for success in clinical trials.

show abstract

Prenatal Intravenous Magnesium at 30-34 Weeks’ Gestation and Neurodevelopmental Outcomes in Offspring

Crowther

Ashwood

Middleton

et al. 2023

JAMA

View full text Add to dashboard Cite

ImportanceIntravenous magnesium sulfate administered to pregnant individuals before birth at less than 30 weeks’ gestation reduces the risk of death and cerebral palsy in their children. The effects at later gestational ages are unclear.ObjectiveTo determine whether administration of magnesium sulfate at 30 to 34 weeks’ gestation reduces death or cerebral palsy at 2 years.Design, Setting, and ParticipantsThis randomized clinical trial enrolled pregnant individuals expected to deliver at 30 to 34 weeks’ gestation and was conducted at 24 Australian and New Zealand hospitals between January 2012 and April 2018.InterventionIntravenous magnesium sulfate (4 g) was compared with placebo.Main Outcomes and MeasuresThe primary outcome was death (stillbirth, death of a live-born infant before hospital discharge, or death after hospital discharge before 2 years’ corrected age) or cerebral palsy (loss of motor function and abnormalities of muscle tone and power assessed by a pediatrician) at 2 years’ corrected age. There were 36 secondary outcomes that assessed the health of the pregnant individual, infant, and child.ResultsOf the 1433 pregnant individuals enrolled (mean age, 30.6 [SD, 6.6] years; 46 [3.2%] self-identified as Aboriginal or Torres Strait Islander, 237 [16.5%] as Asian, 82 [5.7%] as Māori, 61 [4.3%] as Pacific, and 966 [67.4%] as White) and their 1679 infants, 1365 (81%) offspring (691 in the magnesium group and 674 in the placebo group) were included in the primary outcome analysis. Death or cerebral palsy at 2 years’ corrected age was not significantly different between the magnesium and placebo groups (3.3% [23 of 691 children] vs 2.7% [18 of 674 children], respectively; risk difference, 0.61% [95% CI, −1.27% to 2.50%]; adjusted relative risk [RR], 1.19 [95% CI, 0.65 to 2.18]). Components of the primary outcome did not differ between groups. Neonates in the magnesium group were less likely to have respiratory distress syndrome vs the placebo group (34% [294 of 858] vs 41% [334 of 821], respectively; adjusted RR, 0.85 [95% CI, 0.76 to 0.95]) and chronic lung disease (5.6% [48 of 858] vs 8.2% [67 of 821]; adjusted RR, 0.69 [95% CI, 0.48 to 0.99]) during the birth hospitalization. No serious adverse events occurred; however, adverse events were more likely in pregnant individuals who received magnesium vs placebo (77% [531 of 690] vs 20% [136 of 667], respectively; adjusted RR, 3.76 [95% CI, 3.22 to 4.39]). Fewer pregnant individuals in the magnesium group had a cesarean delivery vs the placebo group (56% [406 of 729] vs 61% [427 of 704], respectively; adjusted RR, 0.91 [95% CI, 0.84 to 0.99]), although more in the magnesium group had a major postpartum hemorrhage (3.4% [25 of 729] vs 1.7% [12 of 704] in the placebo group; adjusted RR, 1.98 [95% CI, 1.01 to 3.91]).Conclusions and RelevanceAdministration of intravenous magnesium sulfate prior to preterm birth at 30 to 34 weeks’ gestation did not improve child survival free of cerebral palsy at 2 years, although the study had limited power to detect small between-group differences.Trial Registrationanzctr.org.au Identifier: ACTRN12611000491965

show abstract

Magnesium sulphate given before very‐preterm birth to protect infant brain: the randomised controlled PREMAG trial*

Cited by 256 publications

References 43 publications

RETIRED: Magnesium Sulphate for Fetal Neuroprotection

RETIRED: Magnesium Sulphate for Fetal Neuroprotection

Multifunctional Drugs for Head Injury

Prenatal Intravenous Magnesium at 30-34 Weeks’ Gestation and Neurodevelopmental Outcomes in Offspring

Contact Info

Product

Resources

About