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State-of-the-Art

Magnesium for newborns with hypoxic-ischemic encephalopathy: a systematic review and meta-analysis

Journal of Perinatology volume 33, pages 663–669 (2013)Cite this article

Subjects

Abstract

OBJECTIVE:

Magnesium may have a role in neuroprotection in neonatal hypoxic-ischemic encephalopathy (HIE). The objective of this study was to systematically review the efficacy and safety of postnatal magnesium therapy in newborns with HIE.

STUDY DESIGN:

MEDLINE, EMBASE, CINAHL and CCRCT were searched for studies of magnesium for HIE. Randomized controlled trials that compared magnesium to control in newborns with HIE were selected. The primary outcome was a composite outcome of death or moderate-to-severe neurodevelopmental disability at 18 months. When appropriate, meta-analyses were conducted using random effects model and risk ratios (RRs) and 95% confidence intervals (CIs) were calculated.

RESULT:

Five studies with sufficient quality were included. There was no difference in the primary outcome between the magnesium and the control groups (RR 0.81, 95% CI 0.36 to 1.84). There was significant reduction in the unfavorable short-term composite outcome (RR 0.48, 95% CI 0.30 to 0.77) but no difference in mortality (RR 1.39, 95% CI 0.85 to 2.27), seizures (RR 0.84, 95% CI 0.59 to 1.19) or hypotension (RR 1.28, 95% CI 0.69 to 2.38) between the magnesium and the control groups.

CONCLUSION:

The improvement in short-term outcomes without significant increase in side effects indicate the need for further trials to determine if there are long-term benefits of magnesium and to confirm its safety. Mortality was statistically insignificant between the magnesium and the control groups. However, the trend toward increase in mortality in the magnesium group is a major clinical concern and should be monitored closely in future trials.

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Acknowledgements

We thank Ms Cheri Nickel, the Liberian, at the Hospital for Sick Children for conducting the literature search and Dr Lin Yuan for reviewing the translation of the study published in Chinese. All listed authors are fully involved in the preparation of the manuscript and have approved this final version.

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Authors and Affiliations

  1. Department of Pediatrics, Winnipeg Regional Health Authority, WS012 Women's Hospital, Winnipeg, MB, Canada

    M Tagin

  2. Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    P S Shah

  3. Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    K-S Lee

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  1. M Tagin
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Correspondence to M Tagin.

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The authors declare no conflict of interest.

Additional information

The results of this study were presented, in part, at the annual Pediatric Academic Society meeting in Boston, 28 April to 2 May 2012.

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Tagin, M., Shah, P. & Lee, KS. Magnesium for newborns with hypoxic-ischemic encephalopathy: a systematic review and meta-analysis. J Perinatol 33, 663–669 (2013). https://doi.org/10.1038/jp.2013.65

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