EARLY CEREBRAL NEUROPROTECTION BY MATERNALLY-ADMINISTERED MAGNESIUM SULFATE(MgSO4) IN PRETERM INFANTS IS RELATED TO INITIAL POSTNATAL SERUM MAGNESIUM (Mg) LEVELS. 1504

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INTRODUCTION: We have described a neuroprotective effect in premature infants by maternally-administered MgSO4 in preventing early cerebral injury (Grades III and IV intracranial hemorrhage [ICH] and large[>5 mm] cystic periventricular leukomalacia [CPVL]). We speculated that the degree of neuroprotection may be related to maternal serum Mg level, duration of maternal therapy, or to initial serum Mg levels in the infants on day 1 of life. We performed this investigation to assess these hypotheses.METHODS: From 1991-1994, we prospectively followed 137 ventilated preterm infants (< 33 weeks gestational age) to evaluate acute cerebral injury and long-term neurodevelopmental outcome. 16/61 (26%) infants whose mothers received MgSO4 prior to delivery developed Grade III or IV ICH or CPVL compared to 45/76 (59%) of infants whose mothers did not receive MgSO4. 42/61 (69%) infants whose mothers received MgSO4 had serum Mg levels drawn during the first 24 hours of life and comprise our study population. We ascertained the duration of maternal MgSO4 therapy and their serum Mg levels prior to delivery. RESULTS: CONCLUSION: While there is no association with either duration of maternal therapy or maternal serum Mg levels, initial serum Mg levels in preterm infants directly correlate with prevention of Gr III/IV ICH and CPVL.SPECULATION: Factors positively affecting transplacental passage of Mg may optimize fetal and neonatal Mg levels to enhance neuroprotection.Supported by NIH 5RO1 HD21453-06 Table

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