The possible role of magnesium in protection of premature infants from neurological syndromes and visual impairments and a review of survival of magnesium-exposed premature infants.
The survival rate of very preterm, low birth weight infants (weighing less than 1500 g) is 85 per cent in the USA and is ever increasing, while 42 to 75 per cent of extremely premature infants (weighing 751-1000 g) survive. Of great concern is the lack of consistent decrease in neurological syndromes and associated visual impairments. Because of short gestations, these infants have not had time to accrue up to 80 per cent of magnesium normally present at term. These very preterm infants are at highest risk for cerebral hypoxia/ischemia (H/I), intracranial hemorrhage (ICH), periventricular leukomalacia (PVL) or cystic PVL (CPVL), and possible sequelae, cerebral palsy (CP) and mental retardation (MR). These syndromes are associated with damage to optic structures and the visual pathways which traverse the brain. Visual defects are common in surviving preterm infants. Increased levels of harmful neurochemical mediators that have been reported in these conditions include oxygen free radicals, excitatory amino acids, tumor necrosis factor-alpha (TNF-a), and thromboxane A2 (TXA2) which are aggravated in magnesium deficiency and may be ameliorated by magnesium. We review the published data concerning the effects of prenatal magnesium supplementation on ICH, CPVL, CP and MR and available reports concerning survival. Further considerations on the safety and efficacy of magnesium sulphate administration given prenatally to the preterm neonate await the outcome of three trials that are continuing for more than a year on three continents.
Caddell
J L
JL
Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA 19107-5083, USA.
Graziani
L J
LJ
Wiswell
T E
TE
Hsieh
H C
HC
Mansmann
H C
HC
D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008274:Magnesium / Q000494:pharmacology / Q000627:therapeutic use; D009422:Nervous System Diseases / Q000517:prevention & control*; D013577:Syndrome; D014795:Visual Pathways / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology
D008274:Magnesium