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Antenatal Magnesium Sulfate and adverse gastrointestinal outcomes in Preterm infants-a systematic review and
Arun Prasath1, Nell Aronoff2, Praveen Chandrasekharan1
1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Insights
Antenatal magnesium sulfate (MgSO4) did not increase gastrointestinal issues in preterm infants. This finding supports its routine use in pregnant mothers, as concerns about adverse effects like necrotizing enterocolitis (NEC) are not substantiated by current evidence.
Area of Science:
- Neonatalogy
- Maternal-Fetal Medicine
- Gastroenterology
Background:
- Antenatal magnesium sulfate (MgSO4) is administered to pregnant mothers for various indications.
- Potential adverse effects of MgSO4 on preterm infants' gastrointestinal (GI) system warrant investigation.
Approach:
- A systematic literature search identified 44 studies (38 non-randomized, 6 RCTs) involving 51,466 preterm infants.
- Meta-analysis assessed outcomes including necrotizing enterocolitis (NEC), surgical NEC, spontaneous intestinal perforation (SIP), and feeding intolerance.
- Risk of bias and certainty of evidence (GRADE) were evaluated.
Key Points:
- No increased odds of stage ≥2 NEC, SIP, or feeding intolerance were observed with antenatal MgSO4 exposure.
- A significant reduction in surgical NEC incidence was noted in infants exposed to antenatal MgSO4.
- Evidence regarding GI-related mortality was limited, and overall certainty of evidence was 'very low'.
Conclusions:
- Antenatal MgSO4 does not appear to elevate the risk of GI morbidities or mortality in preterm infants.
- Current evidence suggests that concerns about MgSO4-induced NEC/SIP or GI mortality should not impede its standard use in antenatal care.
Introduction:
To evaluate the effect of antenatal magnesium sulfate (MgSO4) on mortality and morbidity outcomes related to the gastrointestinal system (GI) in preterm infants.
Methods:
Data sources: A systematic literature search was conducted in November 2022. PubMed, CINAHL Plus with Full Text (EBSCOhost), Embase (Elsevier), and CENTRAL (Ovid) were searched. There were 6695 references. After deduplication, 4332 remained. Ninety-nine full-text articles were assessed and forty four articles were included in the final analysis.
Study Eligibility Criteria:
Randomized or quasi-randomized clinical trials and observational studies that evaluated at least one of the pre-specified outcomes were included. Preterm infants whose mothers were given antenatal MgSO4 were included and whose mothers did not receive antenatal MgSO4 were the comparators. The main outcomes and measures were: Necrotizing enterocolitis (NEC) (stage ≥ 2), surgical NEC, spontaneous intestinal perforation (SIP), feeding intolerance, time to reach full feeds, and GI-associated mortality.
Study Appraisal And Synthesis Methods:
A random-effects model meta-analysis was performed to yield pooled OR and its 95% CI for each outcome due to expected heterogeneity in the studies. The analysis for each predefined outcome was performed separately for adjusted and unadjusted comparisons. All included studies were assessed for methodological quality. The risk of bias was assessed using elements of the Cochrane Collaboration's tool 2.0 and the Newcastle-Ottawa Scale for randomized controlled trials (RCTs) and non-randomized studies (NRS), respectively. The study findings were reported as per PRISMA guidelines.
Results:
A total of thirty-eight NRS and six RCTs involving 51,466 preterm infants were included in the final analysis. There were no increased odds of stage ≥2 NEC, (NRS : n = 45,524, OR: 0.95; 95% CI: 0.84-1.08, I2- 5% & RCT's: n = 5205 OR: 1.00; 95% CI: 0.89-1.12, I2- 0%), SIP (n = 34,186, OR: 1.22, 95% CI: 0.94-1.58, I2-30%), feeding intolerance (n = 414, OR: 1.06, 95% CI: 0.64-1.76, I2-12%) in infants exposed to antenatal MgSO4. On the contrary, the incidence of surgical NEC was significantly lower in MgSO4 exposure infants (n = 29,506 OR:0.74; 95% CI: 0.62-0.90, ARR: 0.47%). Studies assessing the effect on GI-related mortality were limited to make any conceivable conclusion. The certainty of evidence (CoE) for all outcomes was adjudged as 'very low' as per GRADE.
Conclusion:
Antenatal magnesium sulfate did not increase the incidence of gastrointestinal-related morbidities or mortality in preterm infants. With the current evidence concerns, regarding the adverse effects of MgSO4 administration leading to NEC/SIP or GI-related mortality in preterm infants should not be a hurdle in its routine use in antenatal mothers.
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