Use of magnesium sulfate in preterm deliveries for neuroprotection of the neonate

Antenatal Low Dose Magnesium Sulphate for Foetal Neuroprotection in Preterm Birth Versus Control: A Comparative Prospective Cohort Study in Tertiary Care Centre in India

Introduction

Preterm infants are at great risk of neurological impairments. This study aimed to evaluate what is the difference in short- and long-term neonatal outcome comparing magnesium sulphate in small dose (4 g) versus controls.

Methods

Prospective cohort study was conducted in the Department of Obstetrics and Gynaecology over a period of 4 years. Group A comprised of the study group (intravenous 4 g magnesium sulphate was given over 20 min). Group B consisted of control group who did not receive magnesium sulphate.

Results

The study population comprised of 116 pregnant women who received intravenous bolus of 4 grams MgSO4 while the control group comprised of 95 pregnant women who did not receive MgSO4. Fewer neonates in the MgSO4 group required intubation at birth (32% vs. 52%) or chest compression (4% vs. 6%); however, the difference was not statistically significantly (p = 0.175 and p = 0.329). Neonatal brain ultrasound done in first month showed a significant reduction intraventricular haemorrhage of severe grade 3-4 IVH in the MgSO4 group (p = 0.016). MgSO4 administration was associated with a decrease in neonatal mortality before discharge (p = 0.039). Follow-up at 3 years showed a significant reduction in delayed milestones, visual impairment, Bayley score < 85 (p = 0.015). MgSO4 treatment antenatally was associated with lower risk of Cerebral Palsy (2.6% vs. 23.2%, p < 0.001).

Conclusion

The benefits from single smaller dose magnesium sulphate 4 gram prove its potential to be used for foetal neuroprotection in any healthcare setting without any maternal concerns.

Preterm Labor and Birth: A Clinical Review

When caring for women experiencing preterm labor and birth, nurses play a significant role as bedside experts, advocates, patient educators, and key members of the maternity care team. Enhanced expertise on clinical and professional knowledge of preterm labor and birth is crucial in prevention and treatment. As preterm birth rates continue to rise, perinatal nurses as well-informed clinical experts have the opportunity to offer innovative education, holistic assessments, and communication through shared decision-making models. Educating pregnant women about early recognition of preterm labor warning signs and symptoms allows for timely diagnosis, interventions, and treatment. Informed and collaborative nursing practice improves quality of clinical care based on individualized interactions. A clinical review of preterm labor and preterm birth is presented for perinatal nurses.

Population Pharmacokinetics of Magnesium Sulfate in Preeclampsia and Associated Factors

Background and Objective

The pharmacokinetic basis of magnesium sulphate (MgSO₄) dosing regimens for preeclampsia (PE) prophylaxis and treatment is not clearly established. The aim of study is to develop a population pharmacokinetic (PK) model of MgSO₄ in PE, and to determine key covariates having an effect in MgSO₄ pharmacokinetics in preeclampsia (PE) and to determine key covariates having an effect in MgSO₄ PK.

Methods

A prospective cohort study was conducted from June 2016 to February 2018 in patients with PE administered MgSO₄ as a 4-g bolus followed by continuous infusion at a rate of 1 g/h. Serum magnesium concentrations were obtained before treatment administration and 2, 6, 12, and 18 h after the initial dose. The software Monolix was used to estimate population PK parameters of MgSO₄ [clearance (CL), volume of distribution (V), half-life] and to develop a PK model with baseline patient demographic, clinical, and laboratory covariates.

Results

The study population consisted of 109 patients. The PK profile of MgSO₄ was adequately described by a one-compartment PK model. The model estimate of the population CL was 1.38 L/h; for V, it was 13.3 L; and the baseline magnesium concentration was 0.77 mmol/L (1.87 mg/dL). The baseline body weight and serum creatinine statistically influenced MgSO₄ CL and V, respectively. The model was parameterized as CL and V.

Conclusion

The PK of MgSO₄ in pregnant women with PE is significantly affected by creatinine and body weight. Pregnant women with PE and higher body weight have a higher V and, consequently, a lower elimination rate of MgSO₄. Pregnant women with PE and a higher serum creatinine value show lower CL and, therefore, lower MgSO₄ elimination rate.

Incidence of Adverse Drug Reactions in High-Risk Pregnancy: A Prospective Cohort Study in Obstetric Intensive Care

PURPOSE

To estimate the cumulative incidence of adverse drug reactions (ADRs) in women with high-risk pregnancy hospitalized in an obstetric intensive care unit, then to describe the medicines involved and to identify major risk factors.

METHODS

From June 2016 to December 2017, patients admitted to the ICU with high-risk pregnancy were considered eligible in this observational, longitudinal, prospective study. Patients were investigated daily for the occurrence of ADRs through pharmaceutical anamnesis, active search in medical records and questioning of the health team. Suspected ADRs were classified according to Naranjo's algorithm. Written informed consent was obtained from all patients. Univariate and multivariate logistic regression were used to identify risk factors of ADR.

RESULTS

The study population consisted of 607 high-risk pregnancies from 851 women admitted to the ICU, of whom 244 admitted for non-obstetric conditions, with an ICU stay less than 24 h or readmitted to the ICU were excluded. The mean age was 27.0 ± 7.5 years-old, mean gestational age was 33.8 ± 6.3 weeks. ADR were observed in 165 women (27.2%). No severe ADR was observed and 29.7% were of moderate severity. The most often implicated medicine was magnesium sulphate (25.2%) with 44.5% of patients administered that substance experiencing ADRs consisting of somnolence (68.6%), absent patellar reflex (21.6%) and hypotension (9.8%). Risk factors of ADR were blood pressure (adjusted odds-ratio (aOR) 1.02), haemoglobin level (aOR 1.21) and body temperature (aOR 0.71).

CONCLUSIONS

ADRs affect about one third of high-risk pregnancies, mainly due to magnesium sulphate administrations. High blood pressure, lower body temperature, and high haemoglobin concentration on admission were associated with an increased risk of ADR.