NEW YORK (Reuters Health) – Giving prenatal magnesium sulfate (MgSO4) to pregnant women at high risk for preterm birth can limit the infant’s risk for cerebral palsy (CP) and possibly death, according to a new meta-analysis.
“Benefit was seen regardless of the reason for preterm birth, across a range of preterm gestational ages, and with minimal variation in outcomes related to time prior to birth or dosage given,” the authors, led by Dr. Caroline A. Crowther of the School of Medicine of the University of Adelaide in Australia, write in their October 4 online report in PLoS Medicine.
“Widespread adoption of the recommendations to use magnesium sulfate within several national clinical practice guidelines, and now within the recent WHO recommendations on interventions to improve preterm birth outcomes, could lead to significant global health benefits,” they add.
In the AMICABLE meta-analysis, Dr. Crowther and colleagues searched standard medical databases through February 2017 and ultimately analyzed five randomized controlled trials of MgSO4 involving 5,493 women and 6,131 babies at risk of preterm birth (<37 weeks’ gestation). All studies reported infants’ neurologic outcomes.
Overall, MgSO4 had no clear benefit over no treatment for preventing death or CP. However, when the analysis was restricted to the four trials in which fetal neuroprotection was the intent of treatment, MgSO4 use significantly reduced the rate of CP or death (15.1% vs. 17.4%; relative risk, 0.86).
The number needed to treat (NNT) to show benefit was 41 women/babies to prevent one baby from either dying or having CP.
For CP among surviving infants, MgSO4 had a strong protective effect in the overall analysis (RR, 0.68; NNT, 46) and in the neuroprotective intent analysis (RR 0.68; NNT, 42).
The authors say their study was strengthened by using individual participant data from all known completed randomized trials of MgSO4 that reported infants’ developmental outcomes.
They advise providers to give the smallest effective dose of MgSO4 for fetal neuroprotection – 4 g with or without a 1-g/hour maintenance dose – close to the time of the planned or expected preterm birth
Dr. Anne Hansen of Boston Children’s Hospital, in Massachusetts, told Reuters Health by email, “Healthcare providers are eager to understand ways to improve the neurodevelopmental outcomes of preterm babies. Some earlier studies were inconclusive, but data that support this conclusion have been accruing, including previous meta-analyses. . . . This research offers a careful, thorough analysis of the major individual studies addressing this topic.”
Dr. Hansen, who was not involved in the current study, noted that about 10% of babies worldwide are born preterm – and agreed with the authors’ advice to give MgSO4 to pregnant women expecting a preterm delivery.
“MgSO4 is generally well tolerated by mother and baby. Side effects for the mother are lower blood pressure, higher heart rate, flushing, nausea, vomiting and sweating. Side effects for newborns are decreased activity level and tone,” she said. “Previous studies also reported lower Apgar scores, higher risk of needing assistance in the delivery room, and higher rates of admission to the neonatal ICU, but this meta-analysis did not find any effects on 5-minute Apgar score or issues related to breathing. This is reassuring.”
Dr. Joshua E. Petrikin of Children’s Mercy Kansas City, in Missouri, also not involved in the study, said by email that the results reaffirm the previously demonstrated benefit of MgSO4 in reducing CP risk in preterm babies.
Looking forward, he noted, “We still do not have evidence-based guidance about which women and infants would most benefit from MgSO4 administration, what the optimal timing and dose would be, whether readministration later in a pregnancy would provide benefit, what lower and upper gestational age should be set for treatment, etc.”
“This meta-analysis is limited by the study quality and data available from the existing studies,” Dr. Petrikin added. “That the authors did not find any subgroup of women or babies who benefited more from treatment (reason for prematurity, varying gestational ages, time from birth when treatment started, differences in dosing regimens, etc.) does not mean that all subgroups benefited equally.”
Dr. Crowther did not respond to requests for comment.
SOURCE: http://bit.ly/2y7vj5U
PLoS Med 2017.
Tidak ada komentar:
Posting Komentar