title: Intrapartum magnesium sulfate and need for intensive delivery room resuscitation.
abstract: OBJECTIVE
  To evaluate the association of intrapartum magnesium sulfate for fetal neuroprotection (MgSO4-FN) with the delivery room resuscitation and neonatal outcomes of preterm infants in an era of minimisation of invasive mechanical ventilation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Neonatal intensive care units in the Canadian Neonatal Network.
  
  
  METHODS
  Preterm infants (23(0) to 31(6) weeks gestational age) born in 2011 or 2012. Resuscitation requirements and neonatal outcomes were compared between infants exposed and unexposed to intrapartum MgSO4-FN.
  
  
  METHODS
  The primary outcome was a composite outcome of 'intensive resuscitation', defined as the need for intubation and ventilation or chest compressions or epinephrine administration in the delivery room. Secondary outcomes included mortality and major neonatal morbidities.
  
  
  RESULTS
  Of 6015 eligible infants, 1387 (23.1%) were exposed to intrapartum MgSO4-FN. Significantly fewer MgSO4-FN infants (41.0% vs 44.6%, p=0.02) required intensive resuscitation. However, after adjustment for confounders, this difference was no longer significant (adjusted OR (AOR) 0.88; 95% CI 0.66 to 1.17). Infants exposed to MgSO4-FN had decreased odds of death (AOR 0.61; 95% CI 0.40 to 0.94), but there was no difference in neonatal morbidities compared with the unexposed infants.
  
  
  CONCLUSIONS
  Intrapartum MgSO4 for fetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation in this cohort of preterm infants.
authors.affiliation: Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Dany E
authors.initials: DE
authors.lastname: Weisz
authors.affiliation: Department of Paediatrics, McMaster Children's Hospital, Hamilton, Canada.
authors.forename: Sandesh
authors.initials: S
authors.lastname: Shivananda
authors.affiliation: Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada Department of Paediatrics, University of Toronto, Toronto, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Asztalos
authors.affiliation: Department of Paediatrics, University of Calgary, Calgary, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Yee
authors.affiliation: Department of Paediatrics, University of British Columbia, Vancouver, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Synnes
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, Canada.
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, Canada Institute of HPME, University of Toronto, Toronto, Canada.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
mesh_terms: D001993:Bronchodilator Agents / Q000008:administration & dosage; D003696:Delivery Rooms; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005865:Gestational Age; D006336:Heart Massage; D006801:Humans; D007231:Infant, Newborn; D008278:Magnesium Sulfate / Q000008:administration & dosage*; D008297:Male; D018696:Neuroprotective Agents; D012121:Respiration, Artificial; D012151:Resuscitation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D018696:Neuroprotective Agents; D008278:Magnesium Sulfate; D004837:Epinephrine
keywords: Neonatology; Neurodevelopment; Outcomes research; Resuscitation