中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (12): 2044-2049.doi: 10.4103/1673-5374.241441

• 综述:神经损伤修复保护与再生 • 上一篇    下一篇

硫酸镁和胎儿神经保护:临床证据概述

  

  • 收稿日期:2018-08-07 出版日期:2018-12-15 发布日期:2018-12-15

Magnesium sulfate and fetal neuroprotection: overview of clinical evidence

Clément Chollat1, 2, Stéphane Marret2, 3   

  1. 1 Institut National de la Santé et de la Recherche Médicale U1245, Genetics and Pathophysiology of Neurodevelopmental Disorders, Team 4 Neovasc, Institute of Research and Innovation in Biomedicine, Rouen School of Medicine, Normandy University, Caen, France
    2 Department of Neonatal Intensive Care, Port Royal University Hospital, Paris, France
    3 Department of Neonatal Pediatrics and Intensive Care and Neuropediatrics, Charles-Nicolle University Hospital, Rouen, France
  • Received:2018-08-07 Online:2018-12-15 Published:2018-12-15
  • Contact: Clément Chollat, MD, PhD,clement.chollat@gmail.com.

摘要:

orcid:0000-0002-0731-5692(Clément Chollat)

Abstract:

Antenatal administration of magnesium sulfate is an important part of the neuroprotective strategy for preterm infants. Strong evidence from five randomized controlled trials and five meta-analyses has demonstrated that magnesium sulfate, when administered before preterm delivery, significantly reduces the risk of cerebral palsy at two years. Through secondary analyses of randomized controlled trials and other original clinical studies, this state-of-the-art review highlights the absence of serious adverse effects in both pregnant women and neonates, as well as the impact of maternal body mass index and preeclamptic status on the maternal and neonatal magnesium levels, which could influence the magnitude of the neuroprotective effect. Although antenatal magnesium sulfate is a cost-effective strategy, some practice surveys have demonstrated that the use of magnesium sulfate is not sufficient and that its use is heterogeneous, differing among different maternity wards. Since 2010, an increasing number of obstetrical societies have recommended its use to improve the neurological outcomes of preterm infants, especially the International Federation of Gynecology and Obstetrics and World Health Organization in 2015, and France in 2017. Considering the neuroprotective impact of magnesium sulfate when administered before delivery, postnatal administration should be considered, and its effects should be assessed using randomized controlled trials.

Key words: magnesium sulfate, preterm birth, neuroprotection, cerebral palsy, neurodevelopment, international recommendations, clinical studies, meta-analysis, preeclampsia, cost-effectiveness