Antenatal Magnesium and Cerebral Palsy in Preterm Infants

作者：Hirtz Deborah G^*; Weiner Steven J; Bulas Dorothy; DiPietro Michael; Seibert Joanna; Rouse Dwight J; Mercer Brian M; Varner Michael W; Reddy Uma M; Iams Jay D; Wapner Ronald J; Sorokin Yoram; Thorp John M Jr; Ramin Susan M; Malone Fergal D; Carpenter Marshall W; O'Sullivan Mary J; Peaceman Alan M; Hankins Gary D V; Dudley Donald; Caritis Steve N

来源：Journal of Pediatrics, 2015, 167(4): 834-+.

DOI：10.1016/j.jpeds.2015.06.067

Objective 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.

• 出版日期2015-10
• 单位NIH; 西北大学