Magnesium sulphate for neuroprotection
Preterm babies are at higher risk of poor neurological outcomes including cerebral palsy. It is biologically plausible that magnesium may provide neuroprotection, it is already used to reduce rates of maternal eclamptic seizures and it has been suggested this is due to magnesium’s direct haemodynamic effect (86).
Blocking voltagedependent calcium channels in the vascular wall leads to cerebral vasodilatation. For the fetus, this will result in an increased cerebral blood flow possibly counteracting the effects of hypoxia and ischaemia on these tissues. Another mechanism may be related to the anti-inflammatory properties of magnesium causing less apoptosis of cells of the fetal brain (87).A Cochrane review in 2010 included five large trials (6145 infants) and found a significant reduction in the risk of cerebral palsy (RR 0.68; 95% CI 0.54-0.87). Current guidance recommends magnesium sulphate in cases of threatened PTL with gestational age of less than 32 weeks (88). However more research is required to determine the optimal doses and duration of treatment required to improve outcome.
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- Arulkumaran S., Ledger W., Denny L., Doumouchtsis S. (eds.). Oxford Textbook of Obstetrics and Gynaecology. Oxford University Press,2020. — 928 p., 2020
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