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Hypermagnesemia and feeding intolerance in preterm infants: A cohort study
Elibene Orro Junqueira1, Sergio Tadeu Martins Marba1, Jamil Pedro de Siqueira Caldas1
1Department of Pediatrics, School of Medical Sciences, State University of Campinas, Campinas, Sao Paulo, Brazil.
Insights
Hypermagnesemia at birth is linked to feeding intolerance in preterm infants. This finding suggests magnesium sulfate exposure may impact infant gut function, requiring further clinical consideration.
Area of Science:
- Neonatal Medicine
- Perinatal Health
- Clinical Pediatrics
Background:
- Feeding intolerance (FI) is a prevalent issue in preterm infants.
- Neonatal disorders and certain medications, such as antenatal magnesium sulfate (MgSO4), can contribute to FI.
Purpose of the Study:
- To investigate the association between hypermagnesemia at birth and the development of feeding intolerance in preterm infants within the first 72 hours of life.
Main Methods:
- A cohort study involving preterm infants (<34 weeks gestation) was conducted.
- Feeding intolerance was defined by specific clinical signs including vomiting, abdominal distension, need for continuous feeding, and delayed meconium passage.
- Hypermagnesemia was identified by umbilical serum magnesium levels exceeding 2.5 mEq/L.
Main Results:
- The study evaluated 251 preterm infants; 17.5% experienced feeding intolerance.
- Hypermagnesemia was significantly more frequent in infants with FI (40.9%) compared to those without (24.2%).
- Hypermagnesemia independently predicted FI (OR, 2.51), alongside maternal diabetes and brain hemorrhage.
Conclusions:
- Hypermagnesemia at birth is an independent risk factor for early feeding intolerance in preterm infants.
- This association highlights the potential impact of magnesium levels on neonatal gastrointestinal function.
- Clinical monitoring for hypermagnesemia may be warranted in preterm infants at risk for feeding intolerance.
Background:
Feeding intolerance (FI) is a common clinical problem in preterm infants often caused by some neonatal disorders and drugs, including antenatal exposure to magnesium sulfate (MgSO4 ).
Objective:
To evaluate the association between hypermagnesemia at birth and FI in preterm infants during the first 72 h of life.
Method:
This was a cohort study conducted with preterm infants aged <34 weeks' gestation. Infants presenting at least two of the following signs were considered as having FI: vomiting, abdominal distension, the need for continuous intermittent feeding, and delayed meconium passage. Hypermagnesemia was characterized by umbilical serum Mg levels > 2.5 mEq/L.
Results:
A total 251 infants were evaluated. The median birth weight and gestational age were 1390 g (IQR, 1020-1070) and 31 weeks (IQR, 28-32). The FI rate was 17.5%. The exposure rate to MgSO4 was similar in the tolerant and intolerant groups (53.1% × 63.6%; P = 0.204), but hypermagnesemia was more frequent in the FI group (40.9% × 24.2%; P = 0.024). The univariate analysis showed that infants with hypermagnesemia were twofold more likely to present FI (odds ratio [OR], 2.16; 95% CI, 1.09-4.26). In the multiple logistic regression analysis, we found that hypermagnesemia was independently associated with FI (OR, 2.51; 95% CI, 1.06-5.91), as well as maternal diabetes mellitus (OR, 2.56; 95% CI, 1.07-6.14), Score for Neonatal Acute Physiology-Perinatal Extension II (OR, 1.051; 95% CI, 1.025-1.078), and brain hemorrhage (OR, 3.61; 95% CI, 1.31-9.91).
Conclusion:
In addition to other factors, hypermagnesemia at birth was independently associated with early FI in preterm infants.
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