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Meta-Analysis
. 2024 Sep;66(9):1157-1172.
doi: 10.1111/dmcn.15899. Epub 2024 Mar 11.

Neonatal magnesium sulphate for neuroprotection: A systematic review and meta-analysis

Emily Shepherd  1   2   3 , Tasneem Karim  3 , Sarah McIntyre  3 , Shona Goldsmith  3 , Amy Keir  1   2 , Nadia Badawi  3   4 , Rod W Hunt  3   5   6   7 , Robert Galinsky  7   8
Affiliations
Meta-Analysis

Neonatal magnesium sulphate for neuroprotection: A systematic review and meta-analysis

Emily Shepherd et al. Dev Med Child Neurol. 2024 Sep.

Abstract

Aim: To review the evidence of the effects of neonatal magnesium sulphate for neuroprotection in perinatal asphyxia and hypoxic-ischaemic encephalopathy (HIE).

Method: This was a systematic review of randomized controlled trials (RCTs) (with meta-analysis) and non-RCTs assessing magnesium sulphate for treating perinatal asphyxia and HIE at 35 weeks or more gestation (primary outcomes: neonatal death and death or long-term major neurodevelopmental disability).

Results: Twenty-five RCTs (2099 infants) and four non-RCTs (871 infants) were included, 23 in low- and middle-income countries (LMICs). In RCTs, reductions in neonatal death with magnesium sulphate versus placebo or no treatment (risk ratio [RR] = 0.68; 95% confidence interval [CI] = 0.53-0.86; 13 RCTs), and magnesium sulphate with melatonin versus melatonin alone (RR = 0.74; 95% CI = 0.58-0.95; one RCT) were observed. No difference in neonatal death was seen for magnesium sulphate with therapeutic hypothermia versus therapeutic hypothermia alone (RR = 0.66, 95% CI = 0.34-1.26; three RCTs), or magnesium sulphate versus phenobarbital (RR = 3.00; 95% CI = 0.86-10.46; one RCT). No reduction in death or long-term neurodevelopmental disability (RR = 0.52; 95% CI = 0.14-1.89; one RCT) but reductions in several short-term adverse outcomes were observed with magnesium sulphate. Evidence was low- to very-low certainty because of risk of bias and imprecision.

Interpretation: Given the uncertainty of the current evidence, further robust neonatal magnesium sulphate research is justified. This may include high-quality studies to determine stand-alone effects in LMICs and effects with and after therapeutic hypothermia in high-income countries.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Effect of magnesium sulphate versus placebo or no treatment on neonatal death. Abbreviation: CI, confidence interval.
FIGURE 2
FIGURE 2
Effect of magnesium sulphate versus placebo or no treatment on death or neurodevelopmental disability at 12 months. Abbreviation: CI, confidence interval.
FIGURE 3
FIGURE 3
Effect of magnesium sulphate and therapeutic hypothermia versus therapeutic hypothermia alone on neonatal death. Abbreviation: CI, confidence interval.
FIGURE 4
FIGURE 4
Effect of magnesium sulphate and therapeutic hypothermia versus therapeutic hypothermia alone on death with a Developmental Assessment Scales for Indian Infants score <70 at 12 months. Abbreviation: CI, confidence interval.
See this image and copyright information in PMC

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