DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20163692

Effect of postnatal magnesium therapy on neonatal seizure in infants with moderate to severe hypoxic ischemic encephalopathy: a post- hoc subgroup analysis

Raj Prakash

Abstract


Background:Magnesium has got both neuroprotective and anticonvulsant effect on developing human brain. A post hoc subgroup analysis was done to determine the effect of magnesium on neonatal seizures in infants with moderate-severe hypoxic ischemic encephalopathy(HIE) who received postnatal magnesium therapy for perinatal asphyxia.

Methods: Term asphyxiated infants were randomly assigned to receive either magnesium sulphate infusion or placebo within 48 hours of life to maintain serum magnesium levels in neuroprotective range. Short term neurological outcome at discharge was evaluated. The post hoc analysis evaluated the effect of magnesium on neonatal seizures in infants with moderate-severe HIE. All statistical analysis was done through SPSS (version 19.0) for windows and p value <0.05 was taken as statistically significant.

Results:Sixty infants were included in magnesium and 60 in placebo group. Both groups were similar in baseline characteristics. Of 36 infants in magnesium group with moderate to severe HIE, 25 (69%) had neonatal seizures vs 27 (82%) of 33 infants in placebo group (p value 0.23). Among those with seizures, seizure control was achieved with single anticonvulsant in 24 infants (96%) in magnesium group vs 20 (74%) in placebo (p value 0.02). Seizures got controlled early in magnesium group compared to placebo, 36.5 hours vs 55 hours (p value 0.02). At discharge, anticonvulsant was required for 2 infants in magnesium group and 3 in placebo group.

Conclusions:Postnatal magnesium therapy as a neuroprotective agent in moderate-severe HIE may decrease the duration of clinical seizures and need for multiple anticonvulsants during the critical period of neuronal damage.  


Keywords


Magnesium sulphate, Newborn, Seizure

Full Text:

PDF

References


Choi DW. The role of glutamate neurotoxicity in hypoxic-ischemic neuronal death. Annu Rev Neurosci. 1990;13:171-82.

Haddad JJ. N-methyl-D-aspartate (NMDA) and the regulation of mitogen-activated protein kinase (MAPK) signaling pathways: A revolving neurochemical axis for therapeutic intervention? Progress Neurobio. 2005;77:252-82.

Cotton DB, Hallak M, Janusz C, Irtenkauf SM, Berman RF. Central anticonvulsant effects of magnesium sulfate on N-methyl-D-aspartate-induced seizures. Am J Obstet Gynecol. 1993;168(3):974-8.

Cotton DB, Janusz CA, Berman RF. Anticonvulsant effects of magnesium sulfate on hippocampal seizures: therapeutic implications in preeclampsia-eclampsia. Am J Obstet Gynecol. 1992;166(4):1127-34.

Standley CA, Irtenkauf SM, Cotton DB. Anticonvulsant effects of magnesium sulfate in hippocampal-kindled rats. J Biomed Sci. 1995;2(1):57-62.

Ichiba H, Tamai H, Negishi H. Randomized controlled trial of magnesium sulfate infusion for severe birth asphyxia. Pediatr Int. 2002;44:505-9.

Ichiba H, Yokoi T. Neurodevelopmental outcome of infants with birth asphyxia treated with magnesium sulfate. Pediatr Int. 2006;48:70-5.

Bhat MA, Charoo BA, Bhat JI, Mushtaq S. Magnesium sulfate in severe perinatal asphyxia: A randomized placebo-controlled trial. Pediatrics. 2009;123:764-9.

Savitha MR, Rajprakash. Beneficial effect of intravenous magnesium sulphate in term neonates with perinatal asphyxia. Int J Contemp Pediatr. 2016;3(1):150-4.

Levene M, Blennow M, Whitelaw A. Acute effects of two different doses of magnesium sulphate in infants with birth asphyxia. Arch Dis Child Fetal Neonatal. 1995;73:174-7.

Crowther A, Janet EH, Lex WD. Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. J Am Med Asso. 2003;290(20):2669-76.

Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2009;1:CD004661.

Gathwala G. Neuronal protection with magnesium. Indian J Pediatr. 2001;68(5):417-9.

Chahal H, Dsouza SW, Barson AJ. Modulation by magnesium of N-methyl-D-aspartate receptors in developing human brain. Arch Dis Child Fetal Neonatal. 1998;78:116-20.