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

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.

• Authors: R Mittendorf, O Dammann, K-S Lee
• Journal: Journal of perinatology : official journal of the California Perinatal Association (J Perinatol) Vol. 26 Issue 1 Pg. 57-63 (Jan 01 2006) ISSN: 0743-8346 [Print] United States
• PMID: 16319938 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Tocolytic Agents
• Magnesium Sulfate

Topics

• Basal Ganglia Cerebrovascular Disease (chemically induced, epidemiology)
• Cerebral Hemorrhage (chemically induced, epidemiology)
• Cerebral Palsy (prevention & control)
• Female
• Humans
• Infant, Newborn
• Magnesium Sulfate (adverse effects, blood, therapeutic use)
• Obstetric Labor, Premature (drug therapy, prevention & control)
• Pregnancy
• Prenatal Exposure Delayed Effects (chemically induced, epidemiology)
• Randomized Controlled Trials as Topic (adverse effects, mortality)
• Tocolytic Agents (adverse effects, blood, therapeutic use)