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magnesium sulfate neuroprotection

Robert Galinsky, Simerdeep K Dhillon, Christopher A Lear, Kyohei Yamaguchi, Guido Wassink, Alistair J Gunn, Laura Bennet
Magnesium sulfate (MgSO4 ) is recommended for preterm neuroprotection, preeclampsia and preterm labor prophylaxis. There is an important unmet need to carefully test clinical interventions in both sexes. Therefore, we aimed to investigate cardiovascular and neurophysiological adaptations to MgSO4 during normoxia and asphyxia in preterm male and female fetal sheep. Fetuses were instrumented at 98{plus minus}1 days of gestation (d; term=147 d). At 104 d, unanaesthetised fetuses were randomly assigned to intravenous MgSO4 (n=12 F, 10 M) or saline (n=13 F, 10 M)...
March 21, 2018: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Lesley M McCowan, Francesc Figueras, Ngaire H Anderson
Small for gestational age is usually defined as an infant with a birthweight <10th centile for a population or customized standard. Fetal growth restriction refers to a fetus that has failed to reach its biological growth potential because of placental dysfunction. Small-for-gestational-age babies make up 28-45% of nonanomalous stillbirths, and have a higher chance of neurodevelopmental delay, childhood and adult obesity, and metabolic disease. The majority of small-for-gestational-age babies are not recognized before birth...
February 2018: American Journal of Obstetrics and Gynecology
Joseph Y Ting, John C Kingdom, Prakesh S Shah
A diagnosis of fetal growth restriction and subsequent preterm birth is associated with increased risks of adverse perinatal and neurodevelopmental outcomes and potentially long-lasting effects to adulthood. Most such cases are associated with placental insufficiency and the fetal response to chronic intrauterine hypoxemia and nutrient deprivation leads to substantial physiological and metabolic adaptations. The management of such pregnancies, especially with respect to perinatal interventions and birth mode, remains an unresolved dilemma...
February 2018: American Journal of Obstetrics and Gynecology
Ingran Lingam, Nicola J Robertson
Magnesium is an intracellular cation essential for many en-zymatic processes and cellular functions. Magnesium sulfate acts as an endogenous calcium channel antagonist at neuronal synapses, thought to prevent excessive activation of N-methyl-D-aspartate receptors by excitatory amino acids, such as glutamate, and by downregulation of proinflammatory pathways. Early intervention is essential in the prevention of the secondary phase of neuronal injury. The immature brain is particularly prone to excitotoxicity, and inflammation has been strongly implicated in the pathogenesis of cerebral palsy...
February 7, 2018: Developmental Neuroscience
Bhawan Deep Garg
AIMS: To evaluate whether antenatal MgSO4 is beneficial or harmful in very preterm and extremely preterm neonates. MATERIALS AND METHODS: We retrieved published literature through searches of PubMed or Medline, CINAHL, and the Cochrane Library. Results were restricted to systematic reviews, meta-analysis, randomized controlled trials (RCTs), and relevant observational studies. RESULTS: Evidence revealed that antenatal MgSO4 has neuroprotective role in preterm neonates and it decreased the risk of cerebral palsy and gross motor dysfunction...
January 17, 2018: Journal of Maternal-fetal & Neonatal Medicine
Xiaolan Li, Huishu Liu, Yuanyuan Yang
Eclampsia is characterized by high morbidity and mortality wordwide. Magnesium sulfate ( MgSO4 ) is used frequently as a prophylaxis for eclamptic seizure in clinical settings. However, the underlying mechanism is less studied, we have previously demonstrated that MgSO4 pretreatment decreases eclampsia-like seizure threshold. Here, we further evaluated the hypothesis that MgSO4 exert neuroprotective actions in eclampsia-like rats model by ameliorating neuroinflammation and brain edema. In this study, the eclampsia-like model was established by administering lipopolysaccharide plus pentylenetetrazol in pregnant Sprague-Dawley rats...
December 27, 2017: Behavioural Brain Research
Sarah R Murray, Sarah J Stock, Jane E Norman
Globally, preterm birth rates are rising and have a significant impact on neonatal morbidity and mortality. Preterm birth remains difficult to prevent and a number of strategies for preterm birth prevention (progesterone, cervical pessaries, cervical cerclage, tocolytics, and antibiotics) have been identified. While some of these show more promise, there is a paucity of evidence regarding the long-term effects of these strategies on childhood outcomes. Strategies used to improve the health of babies if born preterm, such as antenatal magnesium sulfate for fetal neuroprotection and antenatal corticosteroids for fetal lung maturation, show evidence of short-term benefit but lack large-scale follow-up data of long-term childhood outcomes...
December 2017: Seminars in Perinatology
Michal Kovo, Noa Mevorach-Zussman, Nizar Khatib, Yuval Ginsberg, Michael Divon, Zeev Weiner, Jacob Bar, Ron Beloosesky
OBJECTIVES: Multiple mechanisms have been proposed for the neuroprotective effects of magnesium sulfate (MgSO4). We aimed to examine the effects of lipopolysaccharide (LPS) and MgSO4 on the placental expression of nuclear factor κ light chain enhancer of activated B cells (NF-κB), interleukin (IL) 6, adrenocorticotropic hormone (ACTH), and nitric oxide synthase (NOS); all known to participate in the inflammatory cascade. METHODS: Placentas were obtained and selected cotyledons cannulated and dually perfused ex vivo...
January 1, 2017: Reproductive Sciences
D Narasimhulu, A Brown, N M Egbert, M Rojas, S Haberman, A Bhutada, H Minkoff, S Rastogi
OBJECTIVE: The fetus is exposed to magnesium administered to the pregnant mother. However, there is controversy regarding magnesium-related neonatal adverse outcomes, largely driven by a limited understanding of the factors that influence neonatal serum magnesium concentrations and associated outcomes. The objective of this study was to examine the relationship between antenatal maternal magnesium dose and serum concentrations, neonatal serum magnesium concentration and immediate neonatal outcomes...
December 2017: Journal of Perinatology: Official Journal of the California Perinatal Association
Ismaël Daher, Bérénice Le Dieu-Lugon, Nathalie Dourmap, Matthieu Lecuyer, Lauriane Ramet, Cathy Gomila, Jérôme Ausseil, Stéphane Marret, Philippe Leroux, Vincent Roy, Salah El Mestikawy, Stéphanie Daumas, Bruno Gonzalez, Isabelle Leroux-Nicollet, Carine Cleren
Magnesium sulfate (MgSO4) administration to mothers at risk of preterm delivery is proposed as a neuroprotective strategy against neurological alterations such as cerebral palsy in newborns. However, long-term beneficial or adverse effects of MgSO4 and sex-specific sensitivity remain to be investigated. We conducted behavioral and neurochemical studies of MgSO4 effects in males and females, from the perinatal period to adolescence in a mouse model of cerebral neonatal lesion. The lesion was produced in 5-day-old (P5) pups by ibotenate intracortical injection...
October 1, 2017: Journal of Neuropathology and Experimental Neurology
James M O'Brien, Jacobo L Santolaya, Kristy Palomares, David Blitzer, Joaquin Santolaya-Forgas
OBJECTIVE: To evaluate the possible association between antenatal magnesium sulfate treatment with histological chorioamnionitis in patients with singleton or dichorionic twins that had preterm premature rupture of the membranes. METHODS: This was an observational study performed in patients admitted to the hospital with rupture of membranes before 34 weeks' gestation. The primary outcome was histological chorioamnionitis and the primary predictor was antenatal magnesium sulfate treatment...
September 5, 2017: Journal of Perinatal Medicine
Matthieu Lecuyer, Marina Rubio, Clément Chollat, Maryline Lecointre, Sylvie Jégou, Philippe Leroux, Carine Cleren, Isabelle Leroux-Nicollet, Loic Marpeau, Denis Vivien, Stéphane Marret, Bruno J Gonzalez
Clinical studies showed beneficial effects of magnesium sulfate regarding the risk of cerebral palsy. However, regimen protocols fluctuate worldwide and risks of adverse effects impacting the vascular system have been reported for human neonates, keeping open the question of the optimal dosing. Using clinically relevant concentrations and doses of magnesium sulfate, experiments consisted of characterizing, respectively, ex vivo and in vivo, the effects of magnesium sulfate on the nervous and vascular systems of mouse neonates by targeting neuroprotection, angiogenesis, and hemodynamic factors and in measuring, in human fetuses, the impact of a 4-g neuroprotective loading dose of magnesium sulfate on brain hemodynamic parameters...
August 2017: Pharmacology Research & Perspectives
Tyler Vaivada, Michelle F Gaffey, Zulfiqar A Bhutta
CONTEXT: Although effective health and nutrition interventions for reducing child mortality and morbidity exist, direct evidence of effects on cognitive, motor, and psychosocial development is lacking. OBJECTIVE: To review existing evidence for health and nutrition interventions affecting direct measures of (and pathways to) early child development. DATA SOURCES: Reviews and recent overviews of interventions across the continuum of care and component studies...
August 2017: Pediatrics
Yunes Panahi, Mojtaba Mojtahedzadeh, Atabak Najafi, Mohammad Reza Ghaini, Mohammad Abdollahi, Mohammad Sharifzadeh, Arezoo Ahmadi, Seyyed Mahdi Rajaee, Amirhossein Sahebkar
Magnesium (Mg) has been developed as a drug with various clinical uses. Mg is a key cation in physiological processes, and the homeostasis of this cation is crucial for the normal function of body organs. Magnesium sulfate (MgSO4) is a mineral pharmaceutical preparation of magnesium that is used as a neuroprotective agent. One rationale for the frequent use of MgSO4 in critical care is the high incidence of hypomagnesaemia in intensive care unit (ICU) patients. Correction of hypomagnesaemia along with the neuroprotective properties of MgSO4 has generated a wide application for MgSO4 in ICU...
2017: EXCLI journal
Kathleen F Brookfield, Mohammed Elkomy, Felice Su, David R Drover, Brendan Carvalho
The aim of the study was to identify the optimal therapeutic maternal magnesium drug exposure and maternal serum concentration to prevent cerebral palsy in the extremely preterm fetus. We applied a previously constructed pharmacokinetic model adjusted for indication to a large cohort of pregnant women receiving magnesium sulfate to prevent cerebral palsy in their preterm offspring at 20 different US academic centers between December 1997 and May 2004. We simulated the population-based individual maternal serum magnesium concentration at the time of delivery and the total magnesium dose for each woman who received magnesium sulfate to determine the relationship between maternal serum magnesium level at the time of delivery and the development of cerebral palsy...
November 2017: Journal of Clinical Pharmacology
Kristina Shkirkova, Sidney Starkman, Nerses Sanossian, Marc Eckstein, Samuel Stratton, Frank Pratt, Robin Conwit, Scott Hamilton, Latisha Sharma, David Liebeskind, Lucas Restrepo, Miguel Valdes-Sueiras, Jeffrey L Saver
BACKGROUND AND PURPOSE: Paramedic use of fixed-size lumen, gravity-controlled tubing to initiate intravenous infusions in the field may allow rapid start of neuroprotective therapy for acute stroke. In a large, multicenter trial, we evaluated its efficacy in attaining target serum levels of candidate neuroprotective agent magnesium sulfate and the relation of achieved magnesium levels to outcome. METHODS: The FAST-MAG phase 3 trial (Field Administration of Stroke Therapy - Magnesium) randomized 1700 patients within 2 hours of onset to paramedic-initiated, a 15-minute loading intravenous infusion of magnesium or placebo followed by a 24-hour maintenance dose...
July 2017: Stroke; a Journal of Cerebral Circulation
Rodrigo Dias Nunes, Flávia Duarte Schutz, Jefferson Luiz Traebert
PURPOSE: Cerebral palsy is often associated with prematurity and magnesium sulfate (MgSO 4 ) has been used as a neuroprotector, with favorable results. However, its mechanism of action has not been fully elucidated. This study aimed to evaluate the association between MgSO 4 at the imminent premature delivery and neonatal hemodynamic effects. MATERIALS AND METHODS: A cross-sectional study involving 94 newborns (NB) between 24 and 32 weeks at a Brazilian hospital was performed...
June 2, 2017: Journal of Maternal-fetal & Neonatal Medicine
Yuval Ginsberg, Nizar Khatib, Boaz Weiss, Shay Arison, Michael G Ross, Zeev Weiner, Ron Beloosesky
OBJECTIVE: As maternal treatment with magnesium sulfate (MG) may protect the fetal brain, we sought to assess the inflammation associated neuroprotective potential of MG and its association to interleukin 1β (IL-1β). METHODS: Pregnant Sprague-Dawley rats at 18-day gestation received i.p. lipopolysaccharide (LPS) or saline. Dams were randomized to treatment with s.c. saline (control), or MG prior to or following the i.p. injection, resulting in three groups. At the end of the treatment, fetal brain IL-1β was quantified for 18 pregnant rats (six of each group)...
April 12, 2017: Neuroscience
James M Edwards, Laura E Edwards, Geeta K Swamy, Chad A Grotegut
PURPOSE: We examined the effects of magnesium on premature neonatal outcomes complicated by chorioamnionitis. MATERIALS AND METHODS: We conducted a secondary analysis of data from the BEAM Trial, an RCT to determine if antenatal magnesium decreases the incidence of CP in preterm birth. We compared the effect of magnesium sulfate by the presence or absence of chorioamnionitis. Outcomes examined include CP, IVH, NEC, BPD, and assessments of mental and motor disability...
April 11, 2017: Journal of Maternal-fetal & Neonatal Medicine
Eun Jung Jung, Jung Mi Byun, Young Nam Kim, Kyung Bok Lee, Moon Su Sung, Ki Tae Kim, Jong Beom Shin, Dae Hoon Jeong
OBJECTIVE: We aimed to assess the impact of antenatal MgSO4 therapy given to women with PPROM before 32 weeks' gestation on latency, maternal outcomes, perinatal outcomes, and neurodevelopmental outcomes. METHODS: We undertook a retrospective cohort observational study of 184 singleton pregnancies complicated by PPROM at 23°-316  weeks who were hospitalized and received magnesium therapy for tocolysis (MgSO4 group) or did not receive tocolytic therapy (no MgSO4 group) between 2005 and 2013...
June 2018: Journal of Maternal-fetal & Neonatal Medicine
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