Beneficial effect of intravenous magnesium sulphate in term neonates with perinatal asphyxia
Keywords:Magnesium sulphate, Perinatal asphyxia, Neurological abnormalities
Background: The objective of the study was to determine the role of intravenous magnesium sulphate therapy in promoting early recovery and favourable neurological outcome at discharge for asphyxiated term neonates.
Methods: Term neonates with birth asphyxia were assigned randomly, to either magnesium sulphate infusion (Study group) or Comparison group. Neonates in both the groups were treated according to routine NICU protocol for birth asphyxia. Study group in addition received magnesium sulphate intravenous infusion at 250 mg/kg/dose (1 ml/kg/dose in 20 ml of 5% dextrose solution) over 1 hour within 6 hours of birth with 2 additional doses repeated after 24 hours and later at 48 hours. Vitals were monitored continuously. Clinical assessments including detailed neurological examinations were done in both the groups till their discharge from NICU.
Results: Each group included 60 neonates. More number of neonates in the study group had their seizures controlled by a single anticonvulsant as against the comparison group. In the study group 92% neonates had seizure control within 2 days as compared to 70% in the comparison group which was statistically significant(p=0.048). There was early establishment of feeds amongst the study group as against comparison group which was statistically significant. In study group, 47 neonates (84%) recovered from abnormal neurological examination within 4 days as compared to 26 (53%) in comparison group which was statistically significant (p=0.0001).
Conclusions: Intravenous magnesium sulphate within 6 hours of life to term neonates with birth asphyxia helps in early seizure control, early recovery from abnormal neurological signs, early establishment of feeds and fewer chances of neurological abnormalities at discharge.
Choi DW, Rothman SM. The role of glutamate neurotoxicity in hypoxic-ischemic neuronal death. Annu Rev Neurosci. 1990;13:171-82.
Gathwala G. Neuronal protection with magnesium. Indian J Pediatr. 2001;68(5):417-9
Chahal H, D'Souza S, Barson A, Slater P. Modulation by magnesium of N-methyl-D-aspartate receptors in developing human brain. Arch Dis Child Fetal Neonatal Ed. 1998;78(2):116-20.
Szemraja J, Sobolewskab B, Gulczynska E, Wilczynski J, Zylinska L. Magnesium sulfate effect on erythrocyte membranes of asphyxiated newborns. Clinical Biochemistry. 2005;38(5);457-64.
Ichiba H, Tamai H, Negishi H, Ueda T, Kim TJ, Sumida Y et al. Randomized controlled trial of magnesium sulfate infusion for severe birth asphyxia. Pediatr Int. 2002;44(5):505-9.
Ichiba H, Yokoi T, Tamai H, Ueda T, Kim TJ, Yamano T. Neurodevelopmental outcome of infants with birth asphyxia treated with magnesium sulfate. Pediatr Int. 2006;48(1);70-5.
Bhat M A, Charoo B A, Bhat JI, Ahmad SM, Ali SW, Mufti MUH. Magnesium Sulfate in Severe Perinatal Asphyxia: A Randomized Placebo-Controlled Trial. Pediatrics. 2009;123(5):764-9.
McGuire W. Perinatal Asphyxia . BMJ Clin Evid. 2007;2007:0320.
Groenendaal F, Rademaker CM, Toet MC, de Vries LS. Effects of magnesium sulphate on amplitude-integrated continuous EEG in asphyxiated term neonates. Acta Paediatr. 2002;91(10):1073-7.
National Neonatal-Perinatal Database, Human Reproduction Research centre network. Report 2002–2003.Supported by ICMR, New Delhi. Accessed online from 2011.
Levene M, Blennow M, Whitelaw A, Hanko E, Fellman V, Hartley R. Acute effects of two different doses of magnesium sulphate in infants with birth asphyxia. Arch Dis Child Fetal Neonatal Ed. 1995;73(3):174-7.
Gathwala G, Khera A, Singh I. Magnesium Therapy in Birth Asphyxia. Indian J Pediatr. 2006;73(3):209-12.