[Prevention of cerebral palsy using magnesium sulfate in pre-term newborns]

This review concentrates on the best evidence emerging in recent years on cerebral palsy prevention by administration of magnesium sulfate in mothers at risk of pre-term birth before 33-34 weeks' gestation. It was shown in the Cochrane database and in 3 meta-analyses of 5 randomized trials (Magpie Trial [neuroprotection of the pre-eclamptic mother], MagNet [neuroprotection/other intent: tocolysis], ActoMgSO(4) [neuroprotection], PreMag [neuroprotection], and Beam [neuroprotection]) that prenatal low-dose magnesium sulfate given to mothers at risk of pre-term birth has no severe deleterious effects in mothers and does not increase pediatric mortality in very pre-term infants. Moreover, it has significant neuroprotective effects on the occurrence of cerebral palsy at 2 years of age (relative risk, 0.69; 95% confidence interval, 0.54-0.87) and, in the neuroprotection subgroup, on the combined outcome of pediatric mortality or cerebral palsy (relative risk: 0.85; 95% confidence interval: 0.74-0.98). The number needed to treat (NTT) to prevent 1 case of cerebral palsy was 63 (95% CI, 39-172) and the NTT for an extra survivor free of cerebral palsy in the neuroprotection subgroup was 42 (95% CI, 22-357), justifying that magnesium sulfate should be discussed as a stand-alone treatment or as part of a combination treatment.