Antenatal magnesium sulfate therapy: is there a possible neuroprotective role in preterm neonates? a prospective controlled study

ABSTRACT

This controlled randomized comparative study was conducted to analyze the association between antenatal MgSO4 administration and the risk of intraventricullar haemorrhage [IVH] as well as periventricular leucomalacia [PVL] In preterm neonates. Study design: The study comprised a total of 97 parturients with preterm labour and gestations varied between 28 to 35 weeks. They were therapeutically categorized according to the tocolytic used into group I [who received MgSO4, n= 53] and group II [who received ritodrine, n = 44]. Inclusion and exclusion criteria have been described. After birth, the neonates of both groups have been subjected to trans-anterior fontanelle neurosonographic examination. The two groups have been compared for the incidence and grade of severity of abnormal neunosonographic findings with respect to neonatal IVH and PVL. Abnormal neurosonograms were demonstrated in eleven of neonates of group I [20.8%] versus sixteen of the neonates of group II [36.4%]. Out of these, two of the neonates of group I [3.8%] and seven of group II [15.9%] have shown severe abnormality according to papile's criteria. The difference in these neurosonographic abnormalities between the 2 groups has been found to be statistically significant [p < 0.05]. There has been no statistically significant difference between serum Mg level as well as the duration of use of MgSO4 and the occurrence of neurosonographic abnormalities. When logistic regression analysis was utilized and after adjustment for the potential variables, the adjusted odds ratio [OR] was 0.9 and the corresponding confidence interval [CI] = 0.6 - 1.1 when group I was compared to group II. This difference has not been found to be statistically significant [p > 0.05]. After adjustment for the potential confounders, the incidence as well as the severity of IVH and PVL in MgSO4 group has not been found to be statistically different from the ritodrine group. These findings provide a strong support for the hypothesis that MgSO4 therapy could not play an independent cerbroventrscular protective role in preterm neonates