[Neuroprotection for preterm infants with antenatal magnesium sulphate].
OBJECTIVE
To evaluate in preterm born children the neuroprotective benefits and the risks, at short- and long-term outcome, of the antenatal administration of magnesium sulphate (MgSO4) in women at imminent risk of preterm delivery.


METHODS
Computer databases Medline, the Cochrane Library and the recommendations of various international scientific societies.


RESULTS
Given the demonstrated benefit of antenatal MgSO4intravenous administration on the reduction of cerebral palsy rates and the improvement of motor development in children born preterm, it is recommended for all women whose imminent delivery is expected or programmed before 32 weeks of gestation (WG) (grade A). The analysis of the literature finds no argument for greater benefit of antenatal MgSO4administration in sub-groups of gestational age, or depending on the type of pregnancy (single or multiple pregnancy) or with the cause of preterm birth (NP2). Its administration is recommended before 32 WG, if single or multiple pregnancy, whatever the cause of prematurity (grade B). It is recommended 4g loading dose (professional consensus). With a loading dose of 4g intravenous (IV) in 20min, the serum magnesium is lower than with intramuscular suggesting a preference for the IV route (professional consensus). It is proposed to use a maintenance dose of 1g/h until delivery with a maximum recommended duration of 12hours without exceeding a cumulative dose of 50g (professional consensus). These doses are without severe adverse maternal side effects or adverse effects in newborns at short- and medium-term outcome (NP1).


CONCLUSIONS
It is recommended to administer magnesium sulfate to the women at high risk of imminent preterm birth before 32 WG, whether expected or planned (grade A), with a 4g IV loading dose followed by a maintenance dose of 1g/h for 12hours (professional consensus), the pregnancy is single or multiple, whatever the cause of prematurity (professional consensus).
Service de pédiatrie néonatale et réanimation - neuropédiatrie, centre de référence des troubles des apprentissages de l'enfant, CAMSP, hôpital Charles-Nicolle, CHU de Rouen, 76031 Rouen cedex, France; Équipe Inserm-Région (ERI28), handicap périnatal, institut de recherche et d'innovation biomédicale, faculté de médecine et de pharmacie de Rouen, université de Normandie, 76000 Rouen, France. Electronic address: stephane.marret@chu-rouen.fr.
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Équipe Inserm d'épidémiologie obstétricale, périnatale et pédiatrique (U1153), Inserm, centre de recherche d'épidémiologie et biostatistiques Cité Paris Sorbonne, 75005 Paris, France; Université Paris Descartes, Paris, France; Unité de recherche clinique, centre d'investigation clinique, P1419, hôpital Cochin Broca Hôtel-Dieu, 75006 Paris, France.
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D000328:Adult; D002547:Cerebral Palsy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D008278:Magnesium Sulfate / Q000008:administration & dosage / Q000494:pharmacology*; D018696:Neuroprotective Agents / Q000008:administration & dosage / Q000494:pharmacology*; D011247:Pregnancy; D047928:Premature Birth / Q000188:drug therapy*
D018696:Neuroprotective Agents; D008278:Magnesium Sulfate
At school outcome; Cerebral palsy; Devenir scolaire; Hémorragie intracrânienne; Intraventricular haemorrhage; Magnesium sulfate; Paralysie cérébrale; Preterm birth; Prématurité; Sulfate de magnésium