title: Magnesium sulfate, chorioamnionitis, and neurodevelopment after preterm birth.
abstract: OBJECTIVE
  To assess the neuroprotective effect of magnesium sulfate (MgSO4 ) in preterm children exposed to chorioamnionitis.
  
  
  METHODS
  A secondary analysis of a multicentre randomised controlled trial of antenatal MgSO4 administered to women at risk of preterm birth for the prevention of cerebral palsy (CP). Singleton, non-anomalous pregnancies with clinical chorioamnionitis, delivering at ≥24 weeks of gestation, were selected. Cases were exposed to antepartum MgSO4 ; controls received placebo.
  
  
  METHODS
  Multicentre randomised controlled trial.
  
  
  METHODS
  Singleton, non-anomalous pregnancies with clinical chorioamnionitis, delivering at ≥24 weeks of gestation.
  
  
  METHODS
  All data were analysed by intention to treat. Univariate and multivariate analyses were performed.
  
  
  METHODS
  Primary outcome was a composite of stillbirth, death by the age of 1 year, or moderate or severe CP by the age of 2 years. Secondary outcomes included a composite neonatal outcome as well as neurodevelopmental delay, defined as Bayley II mental and psychomotor developmental indices <70 at the age of 2 years. Subgroup analysis assessed these outcomes in children born at <28 weeks of gestation.
  
  
  RESULTS
  A total of 396 children were included, with 192 (48.5%) randomised to MgSO4 . Maternal and delivery characteristics were similar between the groups. The primary outcome occurred in 14.1% of children exposed to MgSO4 and 12.7% of children exposed to placebo (relative risk, RR 1.29; 95% CI 0.70-2.38). Rates of stillbirth, death, moderate-severe CP, and neurodevelopmental delay did not differ between groups. In the subgroup analysis of children born at <28 weeks of gestation, there was no difference in the rates of the primary outcome, nor in the secondary outcomes assessed. [Correction added on 02 March 2016 after online publication: There were errors in statistical data analysis and these have been corrected throughout the article.]
  
  
  CONCLUSIONS
  Among children at risk for early preterm delivery exposed to chorioamnionitis, antenatal administration of MgSO4 was not associated with improved neurodevelopmental outcome. We do not recommend any change in the guidelines on the administration of MgSO4 for neuroprotection based on this study.
  
  
  CONCLUSIONS
  MgSO4 was not associated with improved neurodevelopmental outcome in setting of chorioamnionitis.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kamyar
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Manuck
authors.affiliation: Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Stoddard
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Varner
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA.
authors.forename: Eas
authors.initials: E
authors.lastname: Clark
mesh_terms: D000328:Adult; D002547:Cerebral Palsy / Q000517:prevention & control*; D002821:Chorioamnionitis; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007235:Infant, Premature, Diseases / Q000209:etiology; D008278:Magnesium Sulfate / Q000627:therapeutic use*; D008297:Male; D065886:Neurodevelopmental Disorders / Q000517:prevention & control*; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D011247:Pregnancy; D047928:Premature Birth; D011295:Prenatal Care / Q000379:methods; D011297:Prenatal Exposure Delayed Effects; D011596:Psychomotor Disorders / Q000517:prevention & control; D050497:Stillbirth
chemical_list: D018696:Neuroprotective Agents; D008278:Magnesium Sulfate
keywords: Cerebral palsy; chorioamnionitis; magnesium sulfate; neurodevelopment; preterm