Magnesium sulfate for persistent pulmonary hypertension of the newborn
- PMID: 17636807
- PMCID: PMC8896076
- DOI: 10.1002/14651858.CD005588.pub2
Magnesium sulfate for persistent pulmonary hypertension of the newborn
Abstract
Background: Persistent pulmonary hypertension of the newborn (PPHN) occurs in approximately 1.9 per 1000 newborns and may be more frequent in developing countries. There is strong evidence for the use of inhaled nitric oxide (iNO) and extra corporeal membrane oxygenation (ECMO) in the treatment of PPHN. However, many developing countries do not have access or the technical expertise required for these expensive therapies. Magnesium sulfate is a potent vasodilator and hence has the potential to reduce the high pulmonary arterial pressures associated with PPHN. If magnesium sulfate were found to be effective in the treatment of PPHN, this could be a cost effective and potentially life-saving therapy.
Objectives: To evaluate the use of magnesium sulfate compared with placebo or standard ventilator management alone, sildenafil infusion, adenosine infusion, or inhaled nitric oxide on mortality or the use of backup iNO or ECMO in term and near-term newborns (> 34 weeks gestational age) with PPHN.
Search strategy: The standard search strategy of the Cochrane Neonatal Review Group (CNRG) was used. No language restrictions was applied. The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006) and MEDLINE (1966 to April 20, 2007) were searched for relevant randomized and quasi-randomized trials. In addition the reference lists of retrieved articles were reviewed and known experts were contacted to obtain unpublished data.
Selection criteria: All randomised or quasi-random studies were eligible where one of the treatment groups received magnesium sulfate for PPHN.
Data collection and analysis: Standard methods of the Cochrane Collaboration and the CNRG were used, including independent assessment of trial quality and extraction of data by each author.
Main results: No eligible trials were found
Authors' conclusions: On the basis of the current lack of evidence, the use of magnesium sulphate cannot be recommended in the treatment of PPHN. Randomised controlled trials are recommended.
Conflict of interest statement
None
Update of
- doi: 10.1002/14651858.CD005588
References
References to studies excluded from this review
Abu‐Osba 1992 {published data only}
Baquero 2006 {published data only}
-
- Baquero H, Soliz A, Neira F, Venegas ME, Sola A. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study. Pediatrics 2006;117:1077‐83. - PubMed
Chandran 2004 {published data only}
-
- Chandran S, Haque ME, Wickramasinghe HR, Wint Z. Use of magnesium sulphate in severe persistent pulmonary hypertension of the newborn. Journal of Tropical Pediatrics 2004;50:219‐23. - PubMed
Daffa 2002 {published data only}
-
- Daffa SH, Milaat WA. Role of magnesium sulphate in treatment of severe persistent pulmonary hypertension of the newborn. Saudi Medical Journal 2002;23:1266‐9. - PubMed
Konduri 1996 {published data only}
-
- Konduri GG, Garcia DC, Kazzi NJ, Shankaran S. Adenosine infusion improves oxygenation in term infants with respiratory failure. Pediatrics 1996;97:295‐300. - PubMed
Tolsa 1995 {published data only}
Wu 1995 {published data only}
-
- Wu TJ, Teng RJ, Tsou KI. Persistent pulmonary hypertension of the newborn treated with magnesium sulfate in premature neonates. Pediatrics 1995;96:472‐4. - PubMed
References to ongoing studies
Boo 2004 {unpublished data only}
-
- Ongoing study Starting date of trial not provided. Contact author for more information.
Additional references
Ali 2003
-
- Ali A, Walentik C, Mantych GJ, Sadiq F, Keenan WJ, Noguchi A. Iatrogenic acute hypermagnesemia after total parenteral nutrition infusion mimicking septic shock syndrome: two case reports. Pediatrics 2003;112:e70‐2. URL: http://www.pediatrics.org/cgi/content/full/112/1/e70. - PubMed
Andrews 1965
-
- Andrews BF, Campbell DR, Thomas P. Effects of hypertonic magnesium‐sulphate enemas on newborn and young lambs. Lancet 1965;ii:64‐5.
Bhuta 2005
Bigal 2002
-
- Bigal ME, Bordini CA, Tepper SJ, Speciali JG. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized, double‐blind, placebo‐controlled study. Cephalalgia 2002;22:345‐53. - PubMed
Brady 1967
-
- Brady JP, Williams HC. Magnesium intoxication in a premature infant. Pediatrics 1967;40:100‐3. - PubMed
Costello 1994
Crowther 2003
-
- Crowther CA, Hiller JE, Doyle LW, Haslam RR, Australasian Collaborative Trial of Magnesium Sulphate (ACTOMg SO4) Collaborative Group. Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. JAMA 2003;290:2669‐76. [MEDLINE: ] - PubMed
Crowther 2003a
Davidson 1998
-
- Davidson D, Barefield ES, Kattwinkel J, Dudell G, Damask M, Straube R, et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double‐masked, placebo‐controlled, dose‐response, multicenter study. The I‐NO/PPHN Study Group. Pediatrics 1998;101:325‐34. [MEDLINE: ] - PubMed
Doyle 2009
-
- Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database of Systematic Reviews 2009, Issue 1. [CD004661. DOI: 10.1002/14651858.CD004661.pub3.] - PubMed
Ellis 2000
-
- Ellis M, Manandhar DS, Manandhar N, Wyatt J, Bolam AJ, Costello AM. Stillbirths and neonatal encephalopathy in Kathmandu, Nepal: an estimate of the contribution of birth asphyxia to perinatal mortality in a low‐income urban population. Paediatric and Perinatal Epidemiology 2000;14:39‐52. - PubMed
Finer 2004
Heiden 1999
-
- Heiden A, Frey R, Presslich O, Blasbichler T, Smetana R, Kasper S. Treatment of severe mania with intravenous magnesium sulphate as a supplementary therapy. Psychiatry Research 1999;89:239‐46. - PubMed
Kent 2003
Lipitz 1971
-
- Lipitz JP. The clinical and biochemical effects of excess magnesium in the newborn. Pediatrics 1971;47:501‐9. - PubMed
MAGIC 2002
-
- Magnesium in Coronaries (MAGIC) Trial Investigators. Early administration of intravenous magnesium to high‐risk patients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) Trial: a randomised controlled trial. Lancet 2002;360:1189‐96. - PubMed
Mofenson 1991
-
- Mofenson HC, Caraccio TR. Magnesium intoxication in a neonate from oral magnesium hydroxide laxative. Clinical Toxicology 1991;29:215‐22. - PubMed
Moodley 1998
-
- Moodley J, Matchaba P, Payne AJ. Intrapartum amnioinfusion for meconium‐stained liquor in developing countries. Tropical Doctor 1998;28:31‐4. - PubMed
Nasheit 2003
-
- Nasheit NA. Perinatal and neonatal mortality and morbidity in Iraq. Journal of Maternal‐Fetal & Neonatal Medicine 2003;13:64‐7. - PubMed
Ng 2004
-
- Ng C, Franklin O, Vaidya M, Pierce C, Petros A. Adenosine infusion for the management of persistent pulmonary hypertension of the newborn. Pediatric Critical Care Medicine 2004;5:10‐3. - PubMed
Parida 1997
-
- Parida SK, Baker S, Kuhn R, Desai N, Pauly TH. Endotracheal tolazoline administration in neonates with persistent pulmonary hypertension. Journal of Perinatology 1997;17:461–4. - PubMed
Patole 1995
-
- Patole SK, Finer NN. Experimental and clinical effects of magnesium infusion in the treatment of neonatal pulmonary hypertension. Magnesium Research 1995;8:373‐88. [MEDLINE: ] - PubMed
Rowe 2005
Shekerdemian 2002
-
- Shekerdemian LS, Ravn HB, Penny DJ. Intravenous sildenafil lowers pulmonary vascular resistance in a model of neonatal pulmonary hypertension. American Journal of Respiratory & Critical Care Medicine 2002;165:1098‐102. [MEDLINE: ] - PubMed
Skinner 1993
Sullivan 2000
-
- Sullivan JE, Berman BW. The pediatric forum; hypermagnesemia with lethargy and hypotonia due to administration of magnesium hydroxide to a 4‐week old infant. Archives of Pediatric and Adolescent Medicine 2000;154:1272‐4. - PubMed
Turlapaty 1978
-
- Turlapaty PD, Altura BM. Extracellular magnesium ions control calcium exchange and content of vascular smooth muscle. European Journal of Pharmacology 1978;52:421‐3. - PubMed
Walsh‐Sukys 2000
-
- Walsh‐Sukys MC, Tyson JE, Wright LL, Bauer CR, Korones SB, Stevenson DK, et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics 2000;105:14‐20. [MEDLINE: ] - PubMed
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