MagSulf for neuroprotection (Cochrane review)

Question 1

What was this study’s hypothesis?

Answer 1

To assess the effectiveness and safety of MgSulf for nueroprotection in preterm infants.

Question 2

What type of study was this?

Answer 2

Cochrane systematic review

Question 3

Describe the composition of studies reviewed within this paper:

Answer 3

• 5 trials, 6145 babies, woman at risk of PTB.
• 4 out of 5 trials looked at the use of MgSulf for neuroprotection in women at risk of PTB.
• 1 out of 5 trials (MAGPIE) looked at the use of MgSulf for prevention of eclampsia in preclamptic women.

Question 4

Describe the primary outcomes of this review:

Answer 4

Primary outcomes for infants:

• Death (fetal/neonatal/later)
• Neurological impairment
• Major neurological disability
• Paediatric mortality

Primary outcomes for women:

• Serious adverse cardiovascular/respiratory outcome
• Adverse effects severe enough to stop tx.

Question 5

Describe the secondary outcomes of this review:

Answer 5

Secondary outcomes for infants:

• IVH (intraventricular haemorrhage)
• Periventricular leucomalacia (PVL)
• Apgar <7 at 5 mins
• Need for active resus at birth
• Convulsions
• Hypotonia
• Use of respiratory support
• Chronic lung disease (supplemental oxygen at 28 days postnatal)
• Use of postnatal corticosteroids

Secondary outcomes for child:

• Growth assessments
• Educational achievements.

Secondary outcomes for women:

• Changes in obs during infusions.
• Labour length / need for augmentation
• PPH
• Mode of delivery
• Intrapartum fever requiring antibiotics.
• Breastfeeding post hospital discharge.
• Satisfaction with tx

Secondary outcomes: use of health services

Question 6

What were the main findings and conclusions of this review?

Answer 6

Primary outcomes:

• MgSulf significantly reduces risk of cerebral palsy in preterm infants RR 0.68, with an NNT 63
• MgSulf reduces incidence of gross motor dysfunction RR 0.61
• MgSulf does not have significant effect on paediatric mortality RR 1.04.
• No significant effect on other neurological outcomes.
• Significantly more women ceased MgSulf due to SEs RR 3.26

Conclusions:

• MgSulf significantly reduces cerebral palsy in preterm infants.
• MgSulf has significant (but not dangerous) side-effects on mums.

Question 7

What were the discussion points of this review?

Answer 7

• Most studies do no assess outcomes of CP in late childhood.
• Further studies needed to clarify how MgSulf works; who should receive MgSulf; how best tx should be given; whether MgSulf tx should be repeated.

Question 8

How does Mg prevent post-hypoxic brain injury?

Answer 8

Blocking the excess release of glutamate in the calcium channel..
Fetal and newborn brains seem to be more susceptible to damage from glutamate release.
Consequently, blocking glutamate receptors through agents such as Mg may reduce the risk of injury in the perinatal period