Antenatal Magnesium and Cerebral Palsy in Preterm Infants

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• 作者：Deborah G. Hirtz ; MD¹ ; Steven J. Weiner ; MS² ; Dorothy Bulas ; MD³ ; Michael DiPietro ; MD⁴ ; Joanna Seibert ; MD⁵ ; Dwight J. Rouse ; MD⁶ ; Brian M. Mercer ; MD⁷ ; Michael W. Varner ; MD⁸ ; Uma M. Reddy ; MD ; MPH⁹ ; Jay D. Iams ; MD¹⁰ ; Ronald J. Wapner ; MD¹¹ ; Yoram Sorokin ; MD¹² ; John M. Thorp Jr. ; MD¹³ ; Susan M. Ramin ; MD¹⁴ ; Fergal D. Malone ; MD¹⁵ ; Marshall W. Carpenter ; MD¹⁶ ; Mary J. O'Sullivan ; MD¹⁷ ; Alan M. Peaceman ; MD¹⁸ ; Gary D.V. Hankins ; MD¹⁹ ; Donald Dudley ; MD²⁰ ; Steve N. Caritis ; MD²¹ ; on behalf of the Eunice Kennedy Shriver National Institute of Child Health ; Human Development Maternal-Fetal Medicine Units Network^&lowast ; John C. Hauth ; MD ; Allison Todd ; RN ; MSN ; Tawanda Hill ; RN ; MSN ; Stacy Harris ; RN ; BSN ; Kathleen G. Nelson ; MD ; Fred J. Biasini ; PhD ; Kristine Anderson ; RN ; BSN ; Marla K. Jensen ; BSN ; Lori A. Williams ; RN ; Lisa H. Fullmer ; BSN ; Anna M. Guzman ; RN ; Marc Collin ; MD ; George VanBuren ; MD ; Cynthia Milluzzi ; RN ; BSN ; BFA ; Monica Fundzak ; APN ; MSN ; Cathy Santori ; RN ; Francee Johnson ; BSN ; Mark B. Landon ; MD ; Cheryl Latimer ; BSN ; MS ; Valerie Curry ; BSN ; Sandra Meadows ; BS ; MPH ; Anthony Sciscione ; DO ; Michelle DiVito ; RN ; MSN ; Mary Talucci ; RN ; MSN ; Shobhana A. Desai ; MD ; David A. Paul ; MD ; Baha M. Sibai ; MD ; Risa D. Ramsey ; PhD ; RN ; BSN ; William C. Mabie ; MD ; Lu Kao ; RN ; Melanie Cassie ; RN ; Gwendolyn S. Norman ; RN ; BSN ; MPH ; Debra Driscoll ; RN ; BSN ; Barbara Steffy ; RN ; Mitchell P. Dombrowski ; MD ; Paul J. Meis ; MD ; Melissa Swain ; RN ; Kurt Klinepeter ; MD ; T. Michael O'Shea ; MD ; Linda Steele ; RN ; Kenneth J. Moise Jr. ; MD ; Seth Brody ; MD ; Janice Bernhardt ; RN ; MS ; Karen Dorman ; RN ; MS ; Larry C. Gilstrap III ; MD ; Mary-Clare Day ; RN ; BSN ; Erin Flinn-Gildersleeve ; RN ; BSN ; Felecia Ortiz ; RN ; BSN ; Marcia Kerr ; RN ; Victoria Pemberton ; RN ; MS ; Lisa Paley ; CCRC ; Charles Paley ; MD ; Sabine Bousleiman ; MSN ; MSPH ; Vilmarie Carmona ; JoAnn Tillinghast ; MSN ; Donna Allard ; RNC ; Betty Vohr ; MD ; Lucy Noel ; AD ; Kathleen McCarten ; MD ; Menachem Miodovnik ; MD ; Nancy Elder ; MSN ; Wendy Girdler ; RN ; Teresa L. Gratton ; PA ; Atef Moawad ; MD ; Marshall Lindheimer ; MD ; Phyllis L. Jones ; RN ; BSN ; MPH ; Faith Doyle ; ARNP ; MSN ; Carmen Alfonso ; RN ; May Scott ; RN ; Ramona Washington ; BSN ; Gail Mallett ; RN ; BSN ; Mercedes Ramos-Brinson ; BS ; Paula Simon ; RN ; BSN ; Tony Wen ; MD ; Linda A. Goodrum ; MD ; George R. Saade ; MD ; Gayle L. Olson ; MD ; Hassan M. Harirah ; MD ; Elizabeth Martin ; RN ; Elly M.-J. Xenakis ; MD ; Deborah L. Conway ; MD ; Michael Berkus ; MD ; Theresa M. Kamon ; BSN (deceased) ; Margaret Cotroneo ; RN ; Cheryl A. Milford ; EdS ; M. Lynne Sherman ; RN ; Jody S. Dax ; RN ; BSN ; Lisa Fay-Randall ; RN ; Carla F. Melton ; RN ; Ester Flores ; Elizabeth Thom ; PhD ; Barbara Jones-Binns ; MPH ; Maureen Cooney ; MPH ; Molly L. Fischer ; CRNP ; MPH ; Sarah McLaughlin ; MPH ; Kimberly Brunette ; MPH ; Elizabeth Fricks ; MBA ; Catherine Y. Spong ; MD ; Susan Tolivaisa ; BS ; Donald McNellis ; MD ; Charlotte Catz ; MD ; Kimberly Howell ; MA ; Karin B. Nelson ; MD (consultant) ; James M. Roberts ; MD (MFMU Network Steering Committee Chair)
• 关键词：CP ; Cerebral palsy ; IVH ; Intraventricular hemorrhage ; MgSO4 ; Magnesium sulfate ; MRI ; Magnetic resonance imaging ; PVL ; Periventricular leukomalacia
• 刊名：The Journal of Pediatrics
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：167
• 期：4
• 页码：834-839.e3
• 全文大小：323 K

文摘

To evaluate the relationship of maternal antenatal magnesium sulfate (MgSO₄) with neonatal cranial ultrasound abnormalities and cerebral palsy (CP).

Study design

In a randomized trial of MgSO₄ or placebo in women at high risk of preterm delivery, up to 3 cranial ultrasounds were obtained in the neonatal period. Images were reviewed by at least 2 pediatric radiologists masked to treatment and other clinical conditions. Diagnoses were predefined for intraventricular hemorrhage, periventricular leukomalacia, intracerebral echolucency or echodensity, and ventriculomegaly. CP was diagnosed at 2 years of age by standardized neurologic examination.

Results

Intraventricular hemorrhage, periventricular leukomalacia, intracerebral echolucency or echodensity, and ventriculomegaly were all strongly associated with an increased risk of CP. MgSO₄ administration did not affect the risk of cranial ultrasound abnormality observed at 35 weeks postmenstrual age or later. However, for the 82% of infants born at <32 weeks gestation, MgSO₄ was associated with a reduction in risk of echolucency or echodensity. The reduction in risk for echolucency explained 21% of the effect of MgSO₄ on CP (P = .04), and for echodensity explained 20% of the effect (P = .02).

Conclusions

MgSO₄ given prior to preterm delivery was associated with decreased risk of developing echodensities and echolucencies at <32 weeks gestation. However, this effect can only partially explain the effect of MgSO₄ on CP at 2 years of age.

Trial Registration

tref0015" class="interref" data-locatorType="url" data-locatorKey="http://ClinicalTrials.gov">ClinicalTrials.gov: tref0020" class="interref" data-locatorType="ctgov" data-locatorKey="NCT00014989">NCT00014989.