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Type: Journal article
Title: Effect of magnesium sulfate given for neuroprotection before preterm birth - a randomized controlled trial
Author: Crowther, C.
Hiller, J.
Doyle, L.
Haslam, R.
Citation: JAMA: Journal of the American Medical Association, 2003; 290(20):2669-2676
Publisher: Amer Medical Assoc
Issue Date: 2003
ISSN: 0098-7484
Statement of
Caroline A. Crowther, Janet E. Hiller, Lex W. Doyle and Ross R. Haslam
Abstract: Context: Prenatal magnesium sulfate may reduce the risk of cerebral palsy or death in very preterm infants. Objective: To determine the effectiveness of magnesium sulfate given for neuroprotection to women at risk of preterm birth before 30 weeks' gestation in preventing pediatric mortality and cerebral palsy. Design, Setting, and Patients: Randomized controlled trial at 16 tertiary hospitals in Australia and New Zealand with stratification by center and multiple pregnancy. A total of 1062 women with fetuses younger than 30 weeks' gestation for whom birth was planned or expected within 24 hours were enrolled from February 1996 to September 2000 with follow-up of surviving children at a corrected age of 2 years. Interventions: Women were randomly assigned to receive a loading infusion of 8 mL (4 g [16 mmol] of 0.5 g/mL of magnesium sulfate solution or isotonic sodium chloride solution [0.9%]) for 20 minutes followed by a maintenance infusion of 2 mL/h for up to 24 hours. Main Outcome Measures: Rates of total pediatric mortality, cerebral palsy, and the combined outcome of death or cerebral palsy at a corrected age of 2 years. Results: Data were analyzed for 1047 (99%) 2-year survivors. Total pediatric mortality (13.8% vs 17.1%; relative risk [RR], 0.83; 95% confidence interval [CI], 0.64-1.09), cerebral palsy in survivors (6.8% vs 8.2%; RR, 0.83; 95% CI, 0.54-1.27), and combined death or cerebral palsy (19.8% vs 24.0%; RR, 0.83; 95% CI, 0.66-1.03) were less frequent for infants exposed to magnesium sulfate, but none of the differences were statistically significant. Substantial gross motor dysfunction (3.4% vs 6.6%; RR, 0.51; 95% CI, 0.29-0.91) and combined death or substantial gross motor dysfunction (17.0% vs 22.7%; RR, 0.75; 95% CI, 0.59-0.96) were significantly reduced in the magnesium group. Conclusions: Magnesium sulfate given to women immediately before very preterm birth may improve important pediatric outcomes. No serious harmful effects were seen.
Keywords: Australasian Collaborative Trial of Magnesium Sulphate (ACTOMg SO4) Collaborative Group
Cerebral Palsy
Infant, Premature, Diseases
Magnesium Sulfate
Neuroprotective Agents
Pregnancy Outcome
Infant Mortality
Developmental Disabilities
Pregnancy, High-Risk
Infant, Newborn
Infant, Premature
Obstetric Labor, Premature
Description: © 2003 American Medical Association
DOI: 10.1001/jama.290.20.2669
Published version:
Appears in Collections:Aurora harvest 6
Obstetrics and Gynaecology publications
Paediatrics publications
Public Health publications

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