Risk for Cerebral Palsy After Preterm Birth Is Reduced by Magnesium Sulphate

Supplementation with magnesium sulphate up to 34 weeks’ gestation reduces the risk for cerebral palsy and death at 2 years of age, according to results of an editorial published in Cochrane Database of Systematic Reviews.

Researches conducted a review of data from 6 randomized controlled trials (RCTs) that included outcomes for 5917 women and 6759 babies born before 34 weeks’ gestation. Across the RCTs, magnesium sulphate administration and dosing regimens, as well as upper gestational limits were varied. Overall bias risk was low. Due to concerns regarding quality, imprecision, and inconsistency, certainty of evidence ranged from high to very low.

Magnesium sulphate vs placebo was associated with reduced relative risks for cerebral palsy (risk ratio [RR], 0.71; 95% CI, 0.57-0.89) and cerebral palsy or death (RR, 0.87; 95% CI, 0.77-0.98) up to 2 years’ corrected age. Both relationships were supported by high-certainty evidence.

Magnesium sulphate vs placebo resulted in little to no difference in fetal, neonatal, or later death (RR, 0.96; 95% CI, 0.82-1.13).

Compared with placebo, magnesium sulphate resulted in little to no difference in death up to school age, death or cerebral palsy up to school age, and cerebral palsy at school age.

Magnesium sulphate was not associated with an increased risk for serious maternal complications; however, the severity of adverse effects was increased enough to cease supplementation.

Subgroup analyses for primary outcomes stratified by gestational age, loading dose, maintenance dose, and repeat treatment had ambiguous outcomes.

The review did not assess outcomes on the basis of the cause of preterm birth risk, mode of magnesium sulphate administration, or number of infants in utero. Additional research is needed to address these gaps in knowledge and determine whether magnesium sulphate supplementation may reduce the risk for cerebral palsy in later delivery.

The studies included in this review were conducted in hospital settings that had access to intensive care and essential supportive care for preterm infants. It remains unclear whether these findings may be generalizable to low-resource settings.

“[M]agnesium sulphate given up to 34 weeks’ gestation is effective in reducing cerebral palsy and the combined outcome of death or cerebral palsy at two years’ corrected age. Implementation into clinical practice needs to be accelerated to translate these benefits into better outcomes for preterm babies worldwide,” the study author concluded.