Department of Pediatrics, Winnipeg Regional Health Authority, WS012 Women's Hospital, Winnipeg, MB, Canada.
J Perinatol. 2013 Sep;33(9):663-9. doi: 10.1038/jp.2013.65. Epub 2013 Jun 6.
Magnesium may have a role in neuroprotection in neonatal hypoxic-ischemic encephalopathy (HIE). The objective of this study was to systematically review the efficacy and safety of postnatal magnesium therapy in newborns with HIE.
MEDLINE, EMBASE, CINAHL and CCRCT were searched for studies of magnesium for HIE. Randomized controlled trials that compared magnesium to control in newborns with HIE were selected. The primary outcome was a composite outcome of death or moderate-to-severe neurodevelopmental disability at 18 months. When appropriate, meta-analyses were conducted using random effects model and risk ratios (RRs) and 95% confidence intervals (CIs) were calculated.
Five studies with sufficient quality were included. There was no difference in the primary outcome between the magnesium and the control groups (RR 0.81, 95% CI 0.36 to 1.84). There was significant reduction in the unfavorable short-term composite outcome (RR 0.48, 95% CI 0.30 to 0.77) but no difference in mortality (RR 1.39, 95% CI 0.85 to 2.27), seizures (RR 0.84, 95% CI 0.59 to 1.19) or hypotension (RR 1.28, 95% CI 0.69 to 2.38) between the magnesium and the control groups.
The improvement in short-term outcomes without significant increase in side effects indicate the need for further trials to determine if there are long-term benefits of magnesium and to confirm its safety. Mortality was statistically insignificant between the magnesium and the control groups. However, the trend toward increase in mortality in the magnesium group is a major clinical concern and should be monitored closely in future trials.
镁可能在新生儿缺氧缺血性脑病（HIE）的神经保护中发挥作用。本研究的目的是系统评价镁在 HIE 新生儿中的疗效和安全性。
检索 MEDLINE、EMBASE、CINAHL 和 CCRCT 中关于镁治疗 HIE 的研究。选择比较镁与 HIE 新生儿对照的随机对照试验。主要结局是 18 个月时死亡或中重度神经发育残疾的复合结局。在适当的情况下，采用随机效应模型进行荟萃分析，计算风险比（RR）和 95%置信区间（CI）。
纳入 5 项质量足够的研究。镁组和对照组在主要结局上无差异（RR 0.81，95%CI 0.36 至 1.84）。短期不良复合结局显著降低（RR 0.48，95%CI 0.30 至 0.77），但死亡率（RR 1.39，95%CI 0.85 至 2.27）、癫痫发作（RR 0.84，95%CI 0.59 至 1.19）或低血压（RR 1.28，95%CI 0.69 至 2.38）均无差异。
在没有明显增加副作用的情况下改善短期结局表明需要进一步的试验来确定镁是否有长期益处，并确认其安全性。镁组和对照组之间的死亡率在统计学上无显著性差异。然而，镁组死亡率增加的趋势是一个主要的临床关注点，应在未来的试验中密切监测。
