J Korean Med Sci.  2023 Nov;38(44):e350. 10.3346/jkms.2023.38.e350.

Antenatal Magnesium Sulfate Is Not Associated With Improved Long-Term Neurodevelopment and Growth in Very Low Birth Weight Infants

• Jeon GW
• Ahn SY
• Kim SM
• Yang M
• Sung SI
• Sung JH
• Oh Sy
• Roh CR
• Choi SJ
• Chang YS

• KMID: 2547970
• DOI: http://doi.org/10.3346/jkms.2023.38.e350

Abstract

Background
Though antenatal magnesium sulfate (MgSO₄ ) is widely used for fetal neuroprotection, suspicions about the long-term neuroprotection of antenatal MgSO₄ have been raised.
Methods
We investigated short- and long-term outcomes of antenatal MgSO4 use for 468 infants weighing < 1,500 g with a gestational age of 24–31 weeks.
Results
Short-term morbidities and the risk of developmental delay, hearing loss, and cerebral palsy at a corrected age of 18–24 months and 3 years of age did not decrease in the MgSO₄ group (infants who were exposed to MgSO₄ for any purpose) or neuroprotection group (infants who were exposed to MgSO₄ for fetal neuroprotection) compared with the control group (infants who were not exposed to MgSO₄ ). The z-scores of weight, height, and head circumference did not increase in the MgSO₄ group or neuroprotection group compared with the control group.
Conclusion
Antenatal MgSO₄ including MgSO₄ for neuroprotection did not have beneficial effects on long-term neurodevelopmental and growth outcomes.

Keyword

Magnesium Sulfate; Neuroprotection; Developmental Disabilities; Infant, Very Low Birth Weight; Infant, Premature

Figure

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  Fig. 1 Patient flowchart. Among 609 preterm infants weighing < 1,500 g with GA 24–31 weeks who were admitted from January 2012 to March 2018, 18 with congenital anomalies, 67 who died during hospitalization, and 6 who died between discharge from the neonatal intensive care unit and follow-up 1 were excluded. Among the surviving 518 eligible infants, 50 were not followed-up; hence, a total of 468 infants were included at corrected age of 18–24 months (follow-up 1). Among these 468 infants, 252 were not exposed to MgSO4 (control group) and 216 were exposed to MgSO4 (MgSO4 group) (100 infants for fetal neuroprotection [neuroprotection group], 69 infants to treat maternal preeclampsia or eclampsia, 47 infants to treat maternal preterm labor). At 3 years of age (follow-up 2), among 468 infants who were included at follow-up 1, 78 were not followed-up. None of the infants died between follow-ups 1 and 2. Finally, a total of 390 infants were included at follow-up 2. Among these 390 infants, 197 were not exposed to MgSO4 (control group) and 193 were exposed to MgSO4 (MgSO4 group) (94 infants for fetal neuroprotection [neuroprotection group], 60 infants to treat maternal preeclampsia or eclampsia, and 39 infants to treat maternal preterm labor).GA = gestational age, BWt = birth weight, NICU = neonatal intensive care unit, MgSO4 = magnesium sulfate.

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