INSERM U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Rouen School of Medicine, Normandy University, Rouen, France.
Department of Neonatal Intensive Care, Port Royal University Hospital, APHP, Paris, France.
Dev Med Child Neurol. 2019 Jan;61(1):25-30. doi: 10.1111/dmcn.14038. Epub 2018 Oct 7.
Cerebral palsy (CP) remains the most significant neurological disorder associated with preterm birth. It disrupts quality of life and places huge cost burdens on society. Antenatal magnesium sulphate administration to females before 32 weeks' gestation has proven to be an effective intervention to reduce the rate of CP. In models of hypoxia, hypoxia-ischemia, inflammation, and excitotoxicity in various animal species, magnesium sulphate preconditioning decreased the resulting lesion sizes and inflammatory cytokine levels, prevented cell death, and improved long-term cognitive and motor behaviours. In humans, meta-analyses of five randomized controlled trials using magnesium sulphate as a neuroprotectant showed prevention of CP at 2 years. The benefit remained consistent regardless of gestational age, cause of preterm birth, and total dose received. Antenatal magnesium sulphate treatment is now recommended by the World Health Organization and by many obstetric societies. Its cost-effectiveness further justifies its widespread implementation. WHAT THIS PAPER ADDS: Neuroprotective effect of magnesium sulphate to reduce cerebral palsy in infants born preterm when administered to females at risk of imminent preterm birth. Neuroprotection regardless of gestational age, cause of preterm birth, and total dose. Antenatal magnesium sulphate treatment has good cost-effectiveness.
脑瘫（CP）仍然是与早产相关的最重大的神经障碍。它会破坏生活质量，并给社会带来巨大的经济负担。在妊娠 32 周前对女性进行产前硫酸镁治疗已被证明是一种有效的干预措施，可以降低 CP 的发生率。在各种动物模型中的缺氧、缺氧缺血、炎症和兴奋性毒性中，硫酸镁预处理可减小由此产生的病变大小和炎症细胞因子水平，防止细胞死亡，并改善长期认知和运动行为。在人类中，使用硫酸镁作为神经保护剂的五项随机对照试验的荟萃分析显示，该药物可在 2 年内预防脑瘫。无论胎龄、早产原因和接受的总剂量如何，益处都是一致的。产前硫酸镁治疗现在已被世界卫生组织和许多产科协会推荐。其成本效益进一步证明了其广泛实施的合理性。本文的新发现：在有早产风险的女性中使用硫酸镁进行治疗，可以预防脑瘫，减少因早产而出生的婴儿的神经损伤。神经保护作用与胎龄、早产原因和总剂量无关。产前硫酸镁治疗具有良好的成本效益。
