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Brain lesions in newborns exposed to high-dose magnesium sulfate during preterm labor

Journal of Perinatology volume 26, pages 57–63 (2006)Cite this article

Abstract

High-dosage, tocolytic magnesium sulfate (MgSO4) administered to pregnant women during preterm labor can be toxic, and sometimes lethal, for their newborns (Cochrane Database of Systematic Reviews (relative mortality risk 2.82, 95% confidence interval 1.2–6.6)). Based on the results of the Magnesium and Neurologic Endpoints Trial and the work of many others, a unifying triangular concept is proposed to account for the increased prevalence of brain lesions, with their likely resultant mortality, in neonates and infants exposed to high-dose MgSO4 in the context of preterm labor. We review the evidence that: (1) elevated circulating levels of serum ionized magnesium occurring in mothers, and therefore in their babies, at the time of delivery are associated with subsequent neonatal intraventricular hemorrhage (IVH); (2) neonatal IVH is strongly associated with lenticulostriate vasculopathy (LSV), an unusual mineralizing lesion involving the thalami and basal ganglia of the neonate; and, (3) exposure to 50 g or more of tocolytic MgSO4 during preterm labor is associated with the development of LSV.

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Acknowledgements

Funding for the Magnesium and Neurologic Endpoints Trial at the University of Chicago was provided by the United Cerebral Palsy (UCP) Research and Educational Foundation, Washington, DC. Olaf Dammann received support from the Wilhelm Hirte Stiftung, Hannover, Germany.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL, USA

    R Mittendorf

  2. Neuroepidemiology Unit, Children's Hospital, Harvard Medical School, Boston, MA, USA

    O Dammann

  3. Perinatal Infectious Disease Epidemiology Unit, Hannover Medical School, Hannover, Germany

    O Dammann

  4. Department of Pediatrics, Section of Neonatology, University of Chicago, Chicago, IL, USA

    K-S Lee

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  1. R Mittendorf
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  3. K-S Lee
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Correspondence to R Mittendorf.

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Mittendorf, R., Dammann, O. & Lee, KS. Brain lesions in newborns exposed to high-dose magnesium sulfate during preterm labor. J Perinatol 26, 57–63 (2006). https://doi.org/10.1038/sj.jp.7211419

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