Objective Antenatal magnesium (anteMg) is used for tocolysis pregnancy-induced hypertension (PIH)

Objective Antenatal magnesium (anteMg) is used for tocolysis pregnancy-induced hypertension (PIH) and neuroprotection for preterm birth. MV (eMV) hypotension and other neonatal morbidities and mortality. Logistic regression analysis evaluated the risk of primary outcomes after adjustment for gestational age (GA) center antenatal steroids (ANS) and PIH/eclampsia. Results We evaluated 1 544 infants <29 weeks GA (1 91 in anteMg group and 453 in noMg group). Mothers in the anteMg group were more likely to have higher education PIH/eclampsia and ANS; while their infants were younger in gestation and weighed less (= .07).7 8 A retrospective cohort study of anteMg for prevention of eclampsia noted that longer exposure to anteMg resulted to higher maternal serum magnesium levels and adverse events in the newborn including more episodes of hypotonia delivery room (DR) intubation and admission to special care nursery.9 Another cohort study of Rabbit Polyclonal to GABA-B Receptor. extremely low birth weight infants exposed to anteMg for maternal preeclampsia or preterm labor found a dose-dependent risk for patent ductus arteriosus (PDA) compared to those infants not exposed to anteMg.10 However the Cochrane review by Crowther et al. and another review by Mercer et al. on the use of MgSO4 AS-605240 as a tocolytic agent found similar rates of neonatal mortality or morbidity among exposed and unexposed infants.5 11 Similarly secondary outcomes from the two large RCTs of anteMg versus placebo for fetal neuroprotection failed to demonstrate significant differences in the neonatal mortality and morbidity including DR resuscitation and hypotension requiring treatment with vasopressors.2 3 Lastly further analysis from the Beneficial Effects of Antenatal Magnesium Sulfate (BEAM) Trial found no association between cord blood magnesium level and the need for DR resuscitation.12 In 2010 2010 the American College of Obstetricians and Gynecologists issued a Committee Opinion on the use of MgSO4 for fetal neuroprotection stating that “the available evidence suggests that MgSO4 given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants.”13 This report led to widespread use of MgSO4 among women in preterm labor for fetal neuroprotection. We undertook this Phase IV study of the real world safety and effectiveness of MgSO4 for fetal neuroprotection outside a clinical trial setting. We hypothesized that preterm infants <29 weeks of gestation exposed to anteMg are at AS-605240 risk of adverse cardiorespiratory (CR) effects compared to infants not exposed to anteMg. Material and Methods Study Design and Patient Population In this large retrospective cohort study CR events were compared between preterm neonates with and without exposure to anteMg born at 18 centers of National Institute of Child Health and Human Development (NICHD) Neonatal Research Network's (NRN). Infants born between 23 0/7 weeks and 28 6/7 weeks gestation and enrolled in the GDB from April 1 2011 to March 31 2012 were included in the study. Trained AS-605240 AS-605240 research personnel prospectively collected socio-demographic and clinical data from birth until death discharge or at 120 days of age as part of the NRN Generic Database (GDB) registry. Each center's Institutional Review Board approved the study and data collection procedures. AS-605240 The use of anteMg was documented in the data source; the sign for use had not been. Contact with antenatal magnesium was described by maternal therapy with MgSO4 through the entrance that led to the delivery of the newborn. Gestational age group (GA) was dependant on best obstetric estimation. CR events consist of intubation usage of any MV and treatment of hypotension in the initial 24 hr. of lifestyle. The primary final result was thought as the necessity for DR intubation or the necessity for any mechanised venting (MV) at delivery or in AS-605240 the initial a day of life. Settings of MV included high regularity venting (HFV) oscillator and plane; conventional venting (CV) intermittent necessary venting synchronized intermittent necessary venting (SIMV) and/or support control; sinus SIMV or constant positive airway pressure (CPAP) via sinus prongs. Usage of CV and HFV was thought as endotracheal MV.