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Published on: June 11, 2020
Magnesium sulfate for brain protection in neonatal encephalopathy: a systematic review
Francis B Mimouni1,2, Yuval Dadon3,4,5, Iris Arad1
1Hebrew University of Jerusalem, Jerusalem, Israel.
Objective:
To evaluate the safety and efficacy of postnatal magnesium sulfate (MgSO₄) for neuroprotection in neonates with neonatal encephalopathy (NE).
Study Design:
Systematic review and meta-analysis of controlled clinical trials assessing MgSO₄ administered within 12 h of birth in term or near-term infants with NE. Databases searched included MEDLINE, Embase, and Cochrane sources.
Results:
Twenty-four trials were included. MgSO₄ was consistently safe, with no significant adverse hemodynamic or respiratory effects. Meta-analyses demonstrated improved short-term outcomes, including reduced seizure occurrence, improved neurological status at discharge, and earlier establishment of feeding. No significant reduction in mortality was observed. Evidence regarding long-term neurodevelopmental outcomes was extremely limited. Most pre-therapeutic hypothermia studies demonstrated favorable short-term neurological or clinical outcomes. Studies conducted alongside therapeutic hypothermia have not reported long-term outcomes.
Conclusion:
Postnatal MgSO₄ is safe and associated with improved short-term clinical outcomes in neonates with NE. However, absence of long-term benefit and limited evidence in the era of therapeutic hypothermia preclude routine clinical use.
