产前硫酸镁用于早产神经保护：科威特三级新生儿重症监护病房的单中心经验

Antenatal Magnesium Sulfate for Preterm Neuroprotection: A Single-Center Experience from Kuwait Tertiary NICU.

作者信息

Ayed Mariam, Ahmed Javed, More Kiran, Ayed Amal, Husain Hamid, AlQurashi Ammar, Alrajaan Najla

机构信息

Department of Neonatology, Farwaniya Hospital, Ministry of Health of Kuwait, Kuwait City, Kuwait.

Division of Neonatology, Women's Wellness, and Research Centre, Hamad Medical Corporation, Doha, Qatar.

出版信息

Biomed Hub. 2022 Jun 30;7(2):80-87. doi: 10.1159/000525431. eCollection 2022 May-Aug.

DOI:10.1159/000525431

PMID:35950015

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9294943/

Abstract

OBJECTIVES

The study aimed to evaluate the impact of antenatal exposure of magnesium sulfate (MgSO) on short- and long-term outcomes in preterm neonates born less than 32 weeks gestation.

METHODS

Single-center retrospective cohort study of 229 neonates born between 24 and 32 weeks gestation was conducted from January 2018 through December 2018 in a level III neonatal care unit in Kuwait. Antenatal MgSO exposure was collected from the medical records, and the indication was for neuroprotection effect. Brain MRI was done on 212 neonates (median gestational age 36 weeks), and brain injury was assessed using the Miller's score. Neurodevelopmental outcome was assessed by Bayley-III scales of infant development at 36 months corrected age ( = 146). The association of exposure to MgSO4 with brain injury and neurodevelopmental outcomes was examined using multivariable regression analysis adjusting for gestational age at MRI and variables with value <0.05 on univariate analysis.

RESULTS

Among the 229 neonates, 47 received antenatal MgSO. There were no differences between the groups in gestational age and birth weight. MgSO exposure was not associated with an increased risk of necrotizing enterocolitis, chronic lung disease, retinopathy of prematurity, and mortality. The incidence of cerebellar hemorrhage was significantly less in the MgSO group (0% vs. 16%, value = 0.002). Neonates who received MgSO had lower risks of grade 3-4 intraventricular hemorrhage (IVH) adjusted OR 0.248 (95% CI: 0.092, 0.66), = 0.006; moderate-severe white matter injury (WMI) adjusted odd ratio 0.208 (95% CI: 0.044, 0.96), = 0.046; and grade 3-4 IVH and/or moderate-severe WMI adjusted OR 0.23 (95% CI: 0.06, 0.84), = 0.027. Neurodevelopmental assessment at 36 months corrected age showed better motor (adjusted beta coefficient 1.08 [95% CI: 0.099, 2.06]; = 0.031) and cognitive composite scores (adjusted beta coefficient 1.29 [95% CI: 0.36, 2.22]; = 0.007) in the MgSO group.

CONCLUSION

Antenatal exposure to MgSO in preterm neonates less than 32 weeks was independently associated with lower risks of brain injury and better motor and cognitive outcomes.

摘要

目的

本研究旨在评估产前暴露于硫酸镁（MgSO）对妊娠小于32周的早产新生儿短期和长期结局的影响。

方法

2018年1月至2018年12月在科威特一家三级新生儿重症监护病房对229例妊娠24至32周出生的新生儿进行了单中心回顾性队列研究。从病历中收集产前硫酸镁暴露情况，其指征为神经保护作用。对212例新生儿（中位胎龄36周）进行了脑部MRI检查，并使用米勒评分评估脑损伤情况。在矫正年龄36个月时，采用贝利婴幼儿发展量表第三版（n = 146）评估神经发育结局。采用多变量回归分析，对MRI时的胎龄和单变量分析中P值<0.05的变量进行校正，以检验硫酸镁暴露与脑损伤和神经发育结局之间的关联。

结果

在229例新生儿中，47例接受了产前硫酸镁治疗。两组在胎龄和出生体重方面无差异。硫酸镁暴露与坏死性小肠结肠炎、慢性肺病、早产儿视网膜病变和死亡率的风险增加无关。硫酸镁组小脑出血的发生率显著较低（0%对16%，P值 = 0.002）。接受硫酸镁治疗的新生儿发生3-4级脑室内出血（IVH）的风险较低，校正后的OR为0.248（95%CI：0.092，0.66），P = 0.006；中度至重度白质损伤（WMI）校正后的比值比为0.208（95%CI：0.044，0.96），P = 0.046；3-4级IVH和/或中度至重度WMI校正后的OR为0.23（95%CI：0.06，0.84），P = 0.027。矫正年龄36个月时的神经发育评估显示，硫酸镁组的运动（校正后的β系数为1.08 [95%CI：0.099，2.06]；P = 0.031）和认知综合评分（校正后的β系数为1.29 [95%CI：0.36，2.22]；P = 0.007）更好。