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Updated: May 13, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Baseline serum magnesium concentrations and neurodevelopmental outcomes of extremely low birth weight premature
Susan Y Kim1, Mohamed El-Dib, Tahmina Ahmad
1Department of Neonatology, the George Washington University and Children's National Medical Center, Washington, DC, USA.
Insights
Higher initial serum magnesium levels in extremely low birth weight infants not given antenatal magnesium sulfate were linked to worse neurodevelopmental outcomes and mortality. This suggests magnesium levels may predict infant health after birth.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Biochemistry
Background:
- Antenatal magnesium sulfate (MgSO4) is used to improve neurodevelopmental outcomes (NDO) in extremely low birth weight (ELBW) infants.
- The role of baseline serum magnesium (Mg) in ELBW infants without antenatal MgSO4 exposure is not well understood.
- Understanding factors influencing NDO in ELBW infants is crucial for improving long-term health.
Purpose of the Study:
- To investigate the association between lower baseline serum Mg levels and poorer NDO in ELBW infants who did not receive antenatal MgSO4.
- To determine if initial serum Mg concentration predicts mortality and adverse NDO in this vulnerable population.
Main Methods:
- A two-phase study (retrospective and prospective) involving 156 ELBW infants.
- Initial serum Mg levels were measured within the first 12 hours of life.
- Mortality and NDO at 9 months were assessed and correlated with baseline serum Mg.
Main Results:
- Higher initial serum Mg concentrations were observed in infants who died compared to survivors (Phase 1: p=0.034; Phase 2: p=0.008).
- Elevated serum Mg (>1.6 mg/dL) within 12 hours of birth was associated with unfavorable outcomes (OR=5.5, p=0.037).
- Receiver operating characteristic (ROC) curve analysis indicated a sensitivity of 73% and specificity of 67% for Mg >1.6 mg/dL predicting adverse outcomes.
Conclusions:
- In ELBW infants without antenatal MgSO4, higher initial serum Mg concentrations are positively associated with poor neurodevelopmental outcomes and mortality.
- Further research is needed to explore potential mechanisms, such as dysfunctional Mg transport or active extracellular excretion, in ELBW infants with poor NDO.
Aim:
To test the hypothesis that, in ELBW infants who did not receive antenatal MgSO4, lower baseline serum Mg is associated with poorer neurodevelopmental outcomes (NDO).
Study Design:
The study was conducted in two phases: phase 1-- retrospective, and phase 2--prospective.
Subjects:
Extremely low birth weight infants.
Outcome Measures:
Mortality and adverse NDO were assessed in relation to initial serum Mg measured in the first 12 hours of age.
Results:
We studied 156 ELBW infants. In phase 1 (n=102): initial serum Mg (median [IQ range]) was greater in the infants who died compared to those who survived (1.7 [1.5-2.2] mg/dL vs. 1.6 [1.4-1.7] mg/dL, p=0.034). In phase 2 (n=54): initial serum Mg was greater in infants who died or had adverse NDO at 9 months when compared to those who survived with better NDO (1.7 [1.55-2.1] mg/dL vs. 1.5 [1.4-1.68] mg/dL, p=0.008). Using receiver operating characteristic (ROC) curve, increased Mg concentration in the first 12 hours>1.6 mg/dL was associated with unfavorable outcomes with sensitivity of 73%, specificity of 67%, and odds ratio of 5.5 (CI=1.2-24.8, p=0.037).
Conclusions:
In a cohort of preterm infants without antenatal exposure to MgSO4, initial serum Mg concentrations associated positively with poor outcomes. Further studies are needed in ELBW infants with poor NDO to determine whether they have a dysfunctional transport system that prevents Mg from entering into cells, or they have an active process that excretes Mg extracellularly.
