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Journal of Pediatrics, The

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Antenatal Magnesium and Cerebral Palsy in Preterm Infants - 24/09/15

Doi : 10.1016/j.jpeds.2015.06.067 
Deborah G. Hirtz, MD 1, Steven J. Weiner, MS 2, Dorothy Bulas, MD 3, Michael DiPietro, MD 4, Joanna Seibert, MD 5, Dwight J. Rouse, MD 6, Brian M. Mercer, MD 7, Michael W. Varner, MD 8, Uma M. Reddy, MD, MPH 9, Jay D. Iams, MD 10, Ronald J. Wapner, MD 11, Yoram Sorokin, MD 12, John M. Thorp, MD 13, Susan M. Ramin, MD 14, Fergal D. Malone, MD 15, Marshall W. Carpenter, MD 16, Mary J. O'Sullivan, MD 17, Alan M. Peaceman, MD 18, Gary D.V. Hankins, MD 19, Donald Dudley, MD 20, Steve N. Caritis, MD 21
on behalf of the

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network∗

  List of members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network is available at www.jpeds.com (Appendix).
John C. Hauth, MD, Allison Todd, RN, MSN, Tawanda Hill, RN, MSN, Stacy Harris, RN, BSN, Kathleen G. Nelson, MD, Fred J. Biasini, PhD, Kristine Anderson, RN, BSN, Marla K. Jensen, BSN, Lori A. Williams, RN, Lisa H. Fullmer, BSN, Anna M. Guzman, RN, Marc Collin, MD, George VanBuren, MD, Cynthia Milluzzi, RN, BSN, BFA, Monica Fundzak, APN, MSN, Cathy Santori, RN, Francee Johnson, BSN, Mark B. Landon, MD, Cheryl Latimer, BSN, MS, Valerie Curry, BSN, Sandra Meadows, BS, MPH, Anthony Sciscione, DO, Michelle DiVito, RN, MSN, Mary Talucci, RN, MSN, Shobhana A. Desai, MD, David A. Paul, MD, Baha M. Sibai, MD, Risa D. Ramsey, PhD, RN, BSN, William C. Mabie, MD, Lu Kao, RN, Melanie Cassie, RN, Gwendolyn S. Norman, RN, BSN, MPH, Debra Driscoll, RN, BSN, Barbara Steffy, RN, Mitchell P. Dombrowski, MD, Paul J. Meis, MD, Melissa Swain, RN, Kurt Klinepeter, MD, T. Michael O'Shea, MD, Linda Steele, RN, Kenneth J. Moise, MD, Seth Brody, MD, Janice Bernhardt, RN, MS, Karen Dorman, RN, MS, Larry C. Gilstrap, MD, Mary-Clare Day, RN, BSN, Erin Flinn-Gildersleeve, RN, BSN, Felecia Ortiz, RN, BSN, Marcia Kerr, RN, Victoria Pemberton, RN, MS, Lisa Paley, CCRC, Charles Paley, MD, Sabine Bousleiman, MSN, MSPH, Vilmarie Carmona, JoAnn Tillinghast, MSN, Donna Allard, RNC, Betty Vohr, MD, Lucy Noel, AD, Kathleen McCarten, MD, Menachem Miodovnik, MD, Nancy Elder, MSN, Wendy Girdler, RN, Teresa L. Gratton, PA, Atef Moawad, MD, Marshall Lindheimer, MD, Phyllis L. Jones, RN, BSN, MPH, Faith Doyle, ARNP, MSN, Carmen Alfonso, RN, May Scott, RN, Ramona Washington, BSN, Gail Mallett, RN, BSN, Mercedes Ramos-Brinson, BS, Paula Simon, RN, BSN, Tony Wen, MD, Linda A. Goodrum, MD, George R. Saade, MD, Gayle L. Olson, MD, Hassan M. Harirah, MD, Elizabeth Martin, RN, Elly M.-J. Xenakis, MD, Deborah L. Conway, MD, Michael Berkus, MD, Theresa M. Kamon, BSN (deceased), Margaret Cotroneo, RN, Cheryl A. Milford, EdS, M. Lynne Sherman, RN, Jody S. Dax, RN, BSN, Lisa Fay-Randall, RN, Carla F. Melton, RN, Ester Flores, Elizabeth Thom, PhD, Barbara Jones-Binns, MPH, Maureen Cooney, MPH, Molly L. Fischer, CRNP, MPH, Sarah McLaughlin, MPH, Kimberly Brunette, MPH, Elizabeth Fricks, MBA, Catherine Y. Spong, MD, Susan Tolivaisa, BS, Donald McNellis, MD, Charlotte Catz, MD, Kimberly Howell, MA, Karin B. Nelson, MD : consultant, James M. Roberts, MD : MFMU Network Steering Committee Chair

1 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 
2 Biostatistics Center, The George Washington University, Washington, DC 
3 Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC 
4 Section of Pediatric Radiology, University of Michigan, Ann Arbor, MI 
5 Division of Radiology, Arkansas Children's Hospital, Little Rock, AR 
6 Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 
7 Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, and University of Tennessee, Memphis, TN 
8 Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT 
9 Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 
10 Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 
11 Department of Obstetrics and Gynecology, Thomas Jefferson University and Drexel University, Philadelphia, PA 
12 Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 
13 Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 
14 Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, TX 
15 Department of Obstetrics and Gynecology, Columbia University, New York, NY 
16 Department of Obstetrics and Gynecology, Brown University, Providence, RI 
17 Department of Obstetrics and Gynecology, University of Miami, Miami, FL 
18 Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 
19 Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 
20 Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, TX 
21 Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA 

Abstract

Objective

To evaluate the relationship of maternal antenatal magnesium sulfate (MgSO4) with neonatal cranial ultrasound abnormalities and cerebral palsy (CP).

Study design

In a randomized trial of MgSO4 or placebo in women at high risk of preterm delivery, up to 3 cranial ultrasounds were obtained in the neonatal period. Images were reviewed by at least 2 pediatric radiologists masked to treatment and other clinical conditions. Diagnoses were predefined for intraventricular hemorrhage, periventricular leukomalacia, intracerebral echolucency or echodensity, and ventriculomegaly. CP was diagnosed at 2 years of age by standardized neurologic examination.

Results

Intraventricular hemorrhage, periventricular leukomalacia, intracerebral echolucency or echodensity, and ventriculomegaly were all strongly associated with an increased risk of CP. MgSO4 administration did not affect the risk of cranial ultrasound abnormality observed at 35 weeks postmenstrual age or later. However, for the 82% of infants born at <32 weeks gestation, MgSO4 was associated with a reduction in risk of echolucency or echodensity. The reduction in risk for echolucency explained 21% of the effect of MgSO4 on CP (P = .04), and for echodensity explained 20% of the effect (P = .02).

Conclusions

MgSO4 given prior to preterm delivery was associated with decreased risk of developing echodensities and echolucencies at <32 weeks gestation. However, this effect can only partially explain the effect of MgSO4 on CP at 2 years of age.

Trial Registration

ClinicalTrials.gov: NCT00014989.

Le texte complet de cet article est disponible en PDF.

Keyword : CP, IVH, MgSO4, MRI, PVL


Plan


 Supported by the National Institute of Neurological Disorders and Stroke (NINDS) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; HD27869, HD34208, HD34116, HD40544, HD27915, HD34136, HD21414, HD27917, HD27860, HD40560, HD40545, HD40485, HD40500, HD27905, HD27861, HD34122, HD40512, HD53907, HD34210, HD21410, HD36801, HD19897, and M01-RR-000080). Comments and views of the authors do not necessarily represent the views of the NICHD or NINDS. The authors declare no conflicts of interest.


© 2015  Publié par Elsevier Masson SAS.
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Vol 167 - N° 4

P. 834 - octobre 2015 Retour au numéro
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