The Neuroprotective Efficacy of Postnatal Magnesium Sulfate in Term or Near-Term Infants With Moderate-to-Severe Birth Asphyxia

Abstract

BackgroundIn Pakistan, the neonatal mortality rate is 41 per 1,000 live births and birth asphyxia is one of the leading causes of neonatal mortality and morbidity. The goal of this study was to determine whether postnatal magnesium sulfate therapy can improve short-and long-term neurological outcomes in term or near-term neonates with moderate-to-severe birth asphyxia. MethodologyThis prospective double-blind randomized controlled trial was conducted in the Neonatology Department of the Children's Hospital & The Institute of Child Health, Lahore. A total of 62 neonates (31 in each group) were randomized to receive either three doses of magnesium sulfate infusion at 250 mg/kg per dose, 24 hours apart (treatment group), or three doses of injection 10% distilled water infusion at 3 mL/kg, 24 hours apart (placebo group). Both groups received similar supportive care. The neurodevelopmental assessment was done at six months of age using the ShaMaq Developmental Inventory. ResultsDemographic data such as gestational age, mean weight, age at presentation, gender, hypoxic-ischemic encephalopathy grade, mode of delivery, and the presence of seizures at presentation were comparable between both groups. In the magnesium sulfate group, statistically significant results were seen in terms of early seizure control (p = 0.001), early initiation of feed (p = 0.002), and shorter duration of hospital stay (p = 0.003). Moreover, the magnesium sulfate group had lower mortality compared to the control group, though it was not statistically significant (p = 0.390). There was no significant difference in terms of cranial ultrasound findings between the two groups (p = 0.783) at the time of discharge. Regarding the neurodevelopmental delay, there was no significant difference between the magnesium sulfate and control groups (p = 0.535). ConclusionsPostnatal magnesium sulfate treatment improves short-term neurologic outcomes at discharge in term or near-term neonates with moderate-to-severe perinatal asphyxia. However, no difference was noted in the neurodevelopmental outcome at six months.

Effect of magnesium sulphate infusion on neonatal outcomes in babies with perinatal asphyxia

“…While similar results have been reported by others, very few studies have looked at feeding patterns in case of MgSO4 administration beyond 6 years of life. (18,21,26,30) We found a trend of achieving earlier feeding in the intervention group for babies receiving drug beyond 6 hrs of life as well, but this was not statistically significant.…”

“…Varying results in this outcome have been reported previously with most studies showing no difference between intervention and control groups. (18,21,25,26,28,(30)(31)(32) A systematic review by Tagin et.al even reported a trend toward an increase in mortality in the magnesium group. (22) This difference could be attributed to the variation in the number of doses of magnesium in the studies included in the meta-analysis as well as the small sample sizes of all the studies.…”

“…Similar findings have been noted by other studies for those receiving drug within 6 hours of life. (18,21,25,26,28,30) This is possibly related to neuroprotection offered by magnesium, resulting in earlier recovery from abnormal neurological features of ischemia. The mean duration of hospital stay was significantly lesser in intervention arm in the group getting MgSO4 within 6 hours of birth.…”

Targeting the Multiple Complex Processes of Hypoxia-Ischemia to Achieve Neuroprotection

“…In a clinical trial published in 2021, Iqbal et al divided 62 neonates into two different groups [52]. The treated group (31 neonates) received three doses of MgSO 4 (250 mg/kg) 24 h apart and the placebo group (31 neonates) received distilled water three times 24 h apart.…”

Free Radicals and Neonatal Brain Injury: From Underlying Pathophysiology to Antioxidant Treatment Perspectives

“…In 2013, a metanalysis of the available literature showed a significant reduction of abnormalities at neurological examination or neuroimaging, but failed to prove magnesium efficacy in preventing death, seizure development and moderate-to-severe neurodevelopmental disability at age 18 months [ 185 ]. Later evidence from low-income settings, where magnesium sulfate would represent a potentially viable therapy due to its low cost and ease of delivery, failed to prove substantial developmental and neuroradiological benefits following magnesium sulfate administration in neonatal HIE [ 186 , 187 ], despite reported improvements in seizure burden and neurological examination at discharge [ 188 ]. The lack of substantial effectiveness of magnesium sulfate in relation to neonatal HIE brings the following considerations.…”