Elsevier

The Journal of Pediatrics

Volume 160, Issue 4, April 2012, Pages 573-577.e1
The Journal of Pediatrics

Original Article
Association of Cord Blood Magnesium Concentration and Neonatal Resuscitation

https://doi.org/10.1016/j.jpeds.2011.09.016Get rights and content

Objective

To assess the relationship between umbilical cord blood magnesium concentration and level of delivery room resuscitation received by neonates.

Study design

This was a secondary analysis of a controlled fetal neuroprotection trial that enrolled women at imminent risk for delivery between 24 and 31 weeks’ gestation and randomly allocated them to receive either intravenous magnesium sulfate or placebo. The cohort included 1507 infants with data available on total cord blood Mg concentration and delivery room resuscitation. Multivariate logistic regression was used to estimate the association between cord blood Mg concentration and highest level of delivery room resuscitation, using the following hierarchy: none, oxygen only, bag-mask ventilation with oxygen, intubation, and chest compressions.

Results

There was no relationship between cord blood Mg and delivery room resuscitation (OR, 0.92 for each 1.0-mEq/L increase in Mg; 95% CI, 0.83-1.03). Maternal general anesthesia was associated with increased neonatal resuscitation (OR, 2.51; 95% CI, 1.72-3.68). Each 1-week increase in gestational age at birth was associated with decreased neonatal resuscitation (OR, 0.63; 95% CI, 0.60-0.66).

Conclusion

Cord blood Mg concentration does not correlate with the level of delivery room resuscitation of infants exposed to magnesium sulfate for fetal neuroprotection.

Section snippets

Methods

This study involved a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network trial of MgSO4 for the prevention of cerebral palsy.4 Between December 1997 and May 2004, women at imminent risk for preterm delivery between 24 and 31 weeks’ gestation were randomized to receive intravenous MgSO4 or placebo. MgSO4 (or matching placebo) was given to study participants intravenously as a 6-g loading dose over 20

Results

In the parent study, 2444 fetuses were randomized at 20 sites between December 1997 and May 2004.Of these, 924 were excluded from this secondary analysis because cord blood was unavailable, either because clinical staff were unable to obtain it or an insufficient amount of blood was available after other testing. There were 13 stillbirths. Our study cohort comprised 1507 infants with both cord blood Mg concentration and delivery room resuscitation data. A total of 723 mothers (48.0%) were

Discussion

In the setting of MgSO4 administration for neuroprotection in anticipated preterm birth, we found no association between umbilical cord blood Mg concentration and the receipt of an increased level of delivery room resuscitation in newborn infants, after adjusting for gestational age at birth and several intrapartum exposures. Exposure to general anesthesia was associated with a greater degree of neonatal resuscitation, as has been reported previously.11, 12, 13 Not surprisingly, increasing

References (20)

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Cited by (30)

  • N <sup>o</sup> 376 - Recours au sulfate de magnésium aux fins de neuroprotection fœtale

    2019, Journal of Obstetrics and Gynaecology Canada
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    Toutefois, l'administration prénatale de sulfate de magnésium aux fins de neuroprotection fœtale n'a pas eu d'effet sur l'incidence des indices d'Apgar inférieurs à 7 à cinq minutes de vie (RR : 1,03; IC à 95 % : 0,90–1,18; 3 essais; 4 387 enfants), sur l'hypotonie néonatale (RR : 1,02; IC à 95 % : 0,77–1,36; 1 essai; 2 444 enfants) ni sur le besoin de ventilation continue (RR : 0,94; IC à 95 % : 0,89–1,00; 3 essais; 4 387 femmes). Aucun des principaux essais publiés n'a fourni de données sur le besoin de réanimation active à la naissance41, mais une sous-analyse des données de l'essai BEAM n'a trouvé aucune corrélation entre le taux de magnésium dans le sang de cordon et la nécessité d'une ventilation par ballon-masque, d'une intubation ou de compressions thoraciques60. Un milieu de pratique clinique canadien a récemment montré que l'exposition prénatale au sulfate de magnésium n’était pas associée à un besoin accru de réanimation néonatale intensive61, et des conclusions semblables ont été tirées à la suite d’études menées aux États-Unis62 et au Chili63.

  • No. 376-Magnesium Sulphate for Fetal Neuroprotection

    2019, Journal of Obstetrics and Gynaecology Canada
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    This symptom complex has been described in the neonates of mothers administered large doses of magnesium sulphate IV for eclampsia with neonatal serum levels >4mEq/L.59 However, antenatal magnesium sulphate administered specifically for fetal neuroprotection did not affect the incidence of Apgar score <7at 5 minutes (RR 1.03; 95% CI 0.90–1.18; 3 trials, 4387 infants), neonatal hypotonia (RR 1.02; 95% CI 0.77–1.36; 1trial, 2444 infants), or the need for ongoing ventilatory support (RR 0.94; 95% CI 0.89–1.00; 3 trials; 4387 women). None of the main trial publications reported on the need for active resuscitation at birth,41 but a subanalysis of the BEAM trial found no correlation between cord blood magnesium levels and the need for bag-mask ventilation, intubation, or chest compressions.60 In a more recent Canadian clinical practice setting, exposure to antenatal magnesium sulphate was not associated with an increased need for intensive neonatal resuscitation.61

  • Cord Blood Haptoglobin, Cerebral Palsy and Death in Infants of Women at Risk for Preterm Birth: A Secondary Analysis of a Randomised Controlled Trial

    2019, EClinicalMedicine
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    Because the limit of detection for clinical assays to detect anhaptoglobinemia in adults is 2 mg/dL [22], Western blots were performed on all cord blood samples measuring Hp ≥ 2000 ng/mL by ELISA (n = 507). Analysis of the magnesium concentration in cord serum was performed in a prior study with a minimum detectable magnesium concentration of 0.4 mEq/L [23]. Total protein concentration in cord serum was quantified using bicinchoninic acid assay (Sigma).

  • Delivery Room Resuscitation and Short-Term Outcomes in Moderately Preterm Infants

    2018, Journal of Pediatrics
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    Magnesium may cause adverse events including diminished deep tendon reflexes and respiratory depression when used in the pregnant women.22 However, published reports do not show any association between magnesium sulfate exposure and level of delivery room resuscitation in the neonates.23,24 The association between SGA status and all levels of resuscitation except CPR in MPT infants in our study is consistent with previously reported data in late preterm infants.4,6,20

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Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grants HD27869, HD34208, HD34116, HD40544, HD27915, HD34136, HD21414, HD27917, HD27860, HD40560, HD40545, HD40485, HD40500, HD27905, HD27861, HD34122, HD40512, HD53907, HD34210, HD21410, HD36801, HD19897, MO1-RR-000080) and the National Institute of Neurological Disorders and Stroke. This report does not necessarily represent the official views of the National Institute of Child Health and Human Development, National Institute of Neurological Disorders and Stroke, or the National Institutes of Health. The authors declare no conflicts of interest.

A list of members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network is available at www.jpeds.com (Appendix).

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