Can magnesium sulphate provide neuroprotection in preterm infants? A literature review

The aim of this literature review is to determine if prenatal administration of magnesium sulphate (MgSO4) provides neuroprotection in preterm infants. Data was analysed from five randomised controlled trials (MagNET, ACTOMgSO4, MAGPIE, PREMAG and BEAM). The data from each trial supported a correlation between MgSO4 and neuroprotection; however, only one trial was statistically significant – BEAM. Previously conducted systematic reviews and meta-analyses combined data from the trials and produced statistically significant results in favour of MgSO4 for neuroprotection. Studies suggest that MgSO4 acts as an NMDA (N-Methyl-D-Aspartate) receptor antagonist, reducing the neuronal damage secondary to increased intracellular calcium. Other studies suggest that it prevents neuronal insult by decreasing intrauterine inflammation. The challenges of using MgSO4 are with determining the therapeutic window, appropriate timing of administration, re-treatment possibilities, bias in tocolytic choices, serious maternal side effects (hypotension, tachycardia), and neonatal side effects. Further research is needed to determine the neuroprotective mechanisms, specific indications for MgSO4, optimum gestational age, timing of administration, dosing, and need for re-treatment. Follow-up trials should assess the long-term effects of MgSO4 on preterm infants. In conclusion, MgSO4 provides neuroprotection in preterm infants and likely improves their quality of life.