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Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants

Journal of Perinatology volume 26, pages 521–522 (2006)Cite this article

I read with interest the paper by Verma et al.1 The authors conclude that pulmonary interstitial emphysema is associated with increased mortality in extremely low birth weight infants (ELBW, <1000 g at birth) and that exposure to more than 10 g of magnesium sulfate (MgSO4) is an independent risk factor for PIE in this population.

As the authors mention, MgSO4 tocolysis has been associated with a variety of neonatal morbidities and mortality. The administration of tocolytic MgSO4 to pregnant women during preterm labor is ineffective at delaying birth or preventing preterm birth and at high doses is associated with an increased risk of death in infants (Cochrane Database of Systematic Reviews (relative mortality risk 2.82, 95% confidence interval 1.2–6.6)).2 The Magnesium and Neurologic End points Trial demonstrated an increased prevalence of brain lesions (intraventricular hemorrhage and lenticulostriate vasculopathy) and an increased infant mortality associated with high-dose MgSO4 exposure in the setting of preterm labor.3 Verma et al. raise further concerns about adverse outcomes associated with in utero exposure to MgSO4 in ELBW infants. However, many details were not provided that may allow better insight into the association of MgSO4 with PIE and the specific association of PIE with increased mortality in ELBW infants.

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References

  1. Verma RP, Chandra S, Niwas R, Komaroff E . Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants. J Perinatol 2006; 26: 197–200.

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  2. Crowther CA, Hiller JE, Doyle LW . Magnesium sulphate for preventing preterm birth in threatened preterm labour. Cochrane Database Syst Rev 2002; (4) CD001060.

  3. Mittendorf R, Dammann O, Lee KS . Brain lesions in newborns exposed to high-dose magnesium sulfate during preterm labor. J Perinatol 2006; 26: 57–63.

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  5. Mittendorf R, Stratford R, Khoshnood B, Lee KS, Pryde PG . Persistence of elevated serum magnesium levels in the neonate. Am J Obstet Gynecol 2001; 184: S50.

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  6. Morisot C, Kacet N, Bouchez MC, Rouland V, Dubos JP, Gremillet C et al. Risk factors for fatal pulmonary interstitial emphysema in neonates. Eur J Pediatr 1990; 149: 493–495.

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Acknowledgements

The opinions expressed in this paper are solely those of the authors and do not represent the views of the United States Air Force or Navy, Department of Defense, or the United States Government.

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  1. Department of Neonatology, United States Naval Hospital and Kadena Air Base, Okinawa, Japan

    R M McAdams

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McAdams, R. Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants. J Perinatol 26, 521–522 (2006). https://doi.org/10.1038/sj.jp.7211541

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