Evaluation of safety of magnesium of sulphate therapy in neonates with birth asphyxia

Abstract

Background: Incidence of perinatal asphyxia is about 1 to 1.5% in most centres of world and is usually related to gestational age and birth weight. The incidence is higher in term infants of diabetic and toxaemic mothers. Intrauterine growth retardation, antepartum hemorrhage and breech presentation are also associated with an increased incidence of asphyxia.

Methods: This is a prospective study carried out in Basveshwar & Sangmeshwar Teaching & General Hospitals from 1.12.2007 to 31.5.2009 on 80 terms, appropriate for gestational age babies. They all suffered severe birth asphyxia, of whom 40 formed control group & 40 formed study group. All were treated for birth asphyxia and its complications, except that the study group received injection of magnesium sulphate 250 mg/kg within half an hour of birth and subsequently 125 mg/kg at 24 & 48 hrs of life. Thereafter, they were monitored for effects on vital parameters and immediate outcome.

Results: The mean cord blood serum magnesium level in control and study group was 0.85±0.12 and 0.83±0.10. The serum magnesium levels at 12, 24, 48 and 72 hours were 1.80±0.16, 1.82±0.16, 1.81±0.18, 1.82±0.17 in the study group, which were significantly higher than those in control group. The serum magnesium levels in study group ranged between 1.50 mmol/L & 2.20 mmol/L which are considered to be neuroprotective range. No significant alteration in vital parameters was seen following magnesium infusion. Evidence of HIE was seen more frequently in the control group with 26 (65%) babies showing HIE versus 22 (55%) in the study group. The incidence of HIE, neonatal seizures, & apnoeic spells were lesser in the study group compared to control group.

Conclusions: Injection MgSO4 administered in a dose of 250 mg/kg & 125mg/kg as intravenous infusion is safe, Mg level obtained are in neuroprotective range & it causes better immediate outcome.