Riaz M, Porat R, Brodsky N L, Hurt H
Division of Neonatology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
J Perinatol. 1998 Nov-Dec;18(6 Pt 1):449-54.
To evaluate the effects of maternal magnesium sulfate treatment on newborn outcome.
Subjects were newborn infants delivered at > or = 34 weeks of gestation whose mothers received a minimum of 12 hours of intravenous MgSO4 therapy before delivery. Control infants were the next born infants of similar gestational age. Outcome recorded at delivery included Apgar scores, whether resuscitation was required, and whether respiratory depression or decreased tone were noted by the physician in attendance. Pneumocardiograms on magnesium-exposed and control infants, obtained within 6 to 18 hours after delivery, were analyzed postdischarge by a single investigator who was blinded to group. The nursery course, feeding patterns, time to first stool, and time to first void were recorded. All patient care decisions, including admission to the neonatal intensive care unit (NICU) or term nursery, were independent of study protocol.
A total of 26 magnesium-exposed and 26 control infants were enrolled. The mean total dose of MgSO4 before delivery was 51.2+/-24 gm; the mean duration of therapy was 23.1+/-10 hours. The mean maternal serum magnesium level before delivery was 5.8+/-1.1 mg/dl. The infants' mean cord or initial serum magnesium level was 5.2+/-1.0 mg/dl, which correlated with the maternal magnesium level before delivery (r=0.81, p < 0.001). MgSO4-exposed infants had a higher incidence of hypotonia and lower median Apgar scores than control infants (p < 0.001). However, there was no association between adverse outcomes and maternal serum magnesium concentrations at delivery, duration of treatment, or dose of MgSO4. No difference in dose or length of maternal MgSO4 treatment was noted between infants admitted to term nursery and those admitted to NICU. Pneumocardiogram data were similar between MgSO4-exposed and control infants (all p > or = 0.16). There were no significant differences in number of episodes of feeding intolerance or in time to first stool or void between MgSO4-exposed and control infants (all p > or = 0.31).
Infants born to mothers treated with MgSO4 were more likely to be hypotonic and have lower Apgar scores at birth. Beyond the immediate postdelivery period, there were no additional complications in this cohort attributable to prenatal MgSO4 exposure. We suggest that pediatricians attend deliveries of magnesium-exposed infants.
评估母体硫酸镁治疗对新生儿结局的影响。
研究对象为孕周≥34周的新生儿，其母亲在分娩前至少接受了12小时的静脉硫酸镁治疗。对照婴儿为孕周相似的下一个出生的婴儿。分娩时记录的结局包括阿氏评分、是否需要复苏以及在场医生是否注意到呼吸抑制或肌张力降低。在分娩后6至18小时内获取的暴露于镁和对照婴儿的心电图，在出院后由一位对分组不知情的单一研究者进行分析。记录婴儿室病程、喂养模式、首次排便时间和首次排尿时间。所有患者护理决策，包括入住新生儿重症监护病房（NICU）或足月儿病房，均独立于研究方案。
共纳入26例暴露于镁的婴儿和26例对照婴儿。分娩前硫酸镁的平均总剂量为51.2±24克；平均治疗持续时间为23.1±10小时。分娩前母体血清镁平均水平为5.8±1.1毫克/分升。婴儿的平均脐带或初始血清镁水平为5.2±1.0毫克/分升，与分娩前母体镁水平相关（r = 0.81，p < 0.001）。暴露于硫酸镁的婴儿肌张力低下的发生率较高，出生时阿氏评分中位数较低，低于对照婴儿（p < 0.001）。然而，不良结局与分娩时母体血清镁浓度、治疗持续时间或硫酸镁剂量之间无关联。入住足月儿病房和入住NICU的婴儿之间，母体硫酸镁治疗的剂量或时长无差异。暴露于硫酸镁的婴儿和对照婴儿的心电图数据相似（所有p≥0.16）。暴露于硫酸镁的婴儿和对照婴儿在喂养不耐受发作次数、首次排便时间或首次排尿时间方面无显著差异（所有p≥0.31）。
接受硫酸镁治疗的母亲所生的婴儿出生时更可能肌张力低下且阿氏评分较低。在分娩后即刻之后，该队列中没有因产前暴露于硫酸镁而导致的其他并发症。我们建议儿科医生参与暴露于镁的婴儿的分娩过程。
