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Antenatal magnesium sulfate and spontaneous intestinal perforation in infants less than 25 weeks gestation

B N Rattray1, D M Kraus2, L R Drinker1

  • 1Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|June 6, 2014
PubMed

Insights

High-dose antenatal magnesium sulfate increased the risk of spontaneous intestinal perforation (SIP) and death in extremely low birthweight (ELBW) infants, particularly those born before 25 weeks gestation. Further research is needed to validate these findings.

Area of Science:

  • Neonatalogy
  • Perinatology
  • Pediatric Surgery

Background:

  • Antenatal magnesium sulfate (MgSO4) is used for neuroprotection in extremely low birthweight (ELBW) infants.
  • The impact of magnesium administration protocols on adverse outcomes like spontaneous intestinal perforation (SIP) requires further investigation.

Purpose of the Study:

  • To evaluate the association between antenatal magnesium administration and the incidence of SIP or death in ELBW infants.
  • To assess the effect of a magnesium for neuroprotection protocol (MgPro) on SIP/death rates.

Main Methods:

  • A cohort study of inborn ELBW infants was conducted, comparing outcomes before, during, and after the implementation of an MgPro.
  • Statistical analyses examined the associations between SIP/death, magnesium exposure, gestational age (GA), and their interactions.

Main Results:

  • A higher incidence of SIP was observed when infants were on the MgPro (30.4%) compared to off-protocol (12.9%).
  • Higher antenatal magnesium (Mg) dose was significantly associated with increased risk of SIP/death (OR 9.3), particularly in infants with GA <25 weeks.
  • Gestational age was strongly associated with SIP (P<0.01).

Conclusions:

  • Higher antenatal Mg doses are linked to increased risks of SIP and death in ELBW infants.
  • The association between Mg dose and adverse outcomes appears most pronounced in the most premature infants (<25 weeks gestation).
  • Validation of these findings in larger populations is recommended.
Abstract

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