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Review: antenatal magnesium sulphate prevents cerebral palsy in preterm infants
Evidence-Based Medicine, 10/26/09

Marlow N – Given before anticipated preterm birth, maternal magnesium sulphate prevents cerebral palsy in preterm infants.

• Cochrane Pregnancy and Childbirth Group’s Trials Register (which contains results of searches of Cochrane Central Register of Controlled Trials, Medline, 30 journals, and major conference proceedings) was searched in August 2008 for randomised controlled trials (RCTs). 5 articles describing 6 RCTs (n = 6145 babies) met the selection criteria; in 4 RCTs, neuroprotection of the fetus was the primary objective of the trial.
• Included studies compared magnesium sulphate (administered intravenously, intramuscularly, or orally) with placebo, no treatment, or an alternate treatment (control) as a neuroprotective agent for the fetus when given to women at risk of preterm delivery.
• Studies in which the primary aim was other than fetal neuroprotection (eg, treatment of pre–eclampsia or preterm labour) were included if long–term infant neurological outcomes were reported.
• Outcomes were fetal/infant death, cerebral palsy, neurological impairment, and maternal side effects (such as nausea, vomiting, headache, palpitations, and flushing). Infants were evaluated at 18–24 months of age (corrected for prematurity) by blinded outcome assessors.

• Antenatal magnesium sulphate reduced risk of cerebral palsy and substantial gross motor dysfunction but not fetal/infant death.
• Groups did not differ for neurological impairment, blindness, deafness, developmental delay or intellectual impairment, or major neurological disability.
• Women in the magnesium sulphate group were 3 times more likely than those in the placebo group to discontinue treatment because of side effects.

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