The following is a summary of “Antenatal Neuroprotective Magnesium Sulfate in Very Preterm Infants and Its Association With Feeding Intolerance,” published in the November 2023 issue of Pediatrics by Bekmez, et al.
Magnesium sulfate (MgSO4) is a widely employed intervention for fetal neuroprotection, although concerns persist regarding potential side effects. The impact of varying cumulative maternal doses and resulting neonatal serum magnesium (Mg) levels on short-term neonatal morbidity and mortality remains an area of limited exploration. For a study, researchers sought to assess the influence of neonatal serum Mg levels on immediate neonatal outcomes, shedding light on the nuanced relationship between MgSO4 exposure and neonatal health.
Conducted between 2017 and 2021, the study focused on inborn preterm infants delivered between 23 and 31 6/7 weeks of gestation. Exclusion criteria encompassed factors such as advanced resuscitation, inotropic treatment, >12 hours post-discontinuation of maternal MgSO4, severe anemia, and major congenital/chromosomal anomalies. Neonates with serum Mg levels at the 6th hour of life were stratified based on a 2.5 mg/dL threshold. Analyses were performed to compare MgSO4-exposed and non-exposed groups, evaluating various neonatal outcomes.
Among the 584 infants, 310 received antenatal MgSO4. The MgSO4-exposed group exhibited lower birth weights, increased antenatal corticosteroid usage, and a higher incidence of intrauterine growth restriction. Neonates in the MgSO4 group were more prone to bronchopulmonary dysplasia, prolonged invasive ventilation, necrotizing enterocolitis, delayed enteral nutrition, and feeding intolerance (P < 0.05). MgSO4 treatment emerged as an independent risk factor for feeding intolerance after adjusting for confounders (odds ratio 2.13, 95% CI: 1.4–3.1, P = 0.001). Serum Mg levels were significantly correlated with feeding intolerance (r = 0.21, P = 0.002).
The study underscored the impact of MgSO4 treatment on neonatal outcomes, emphasizing the potential of serum Mg levels as a predictive marker, particularly for delayed enteral nutrition and feeding intolerance. Further investigations were warranted to establish the optimal serum Mg concentration in early life for preterm infants, balancing therapeutic benefits with minimal side effects.
Source: journals.lww.com/jpgn/abstract/2023/11000/antenatal_neuroprotective_magnesium_sulfate_in.7.aspx
