Background: A neuroprotective effect of MgSO4 has been shown in some animal models of perinatal hypoxic–ischemic brain damage. The aim of the present paper was to determine whether postnatal MgSO4 infusion (250 mg/kg per day i.v. for 3 days, in combination with dopamine) is safe in infants with severe birth asphyxia, and also observe effects on neurodevelopmental outcome at 18 months.
Methods: Inclusion criteria were clinical history consistent with perinatal asphyxia; gestational age at least 37 weeks; 5 min Apgar score ≤6; failure to initiate spontaneous respiration within 10 min after birth; and symptoms of encephalopathy. On each day MgSO4 was infused over 1 h in combination with dopamine (5 μg/kg per min). Changes in vital signs, clinical course of encephalopathy, laboratory variables, and adverse events were monitored. Infants were followed for 18 months.
Results: Thirty infants were studied. Mean birthweight was 2878 g; mean gestational age, 39.6 weeks, and median 5 min Apgar score, 3. All required endotracheal intubation for resuscitation. Median age at MgSO4 initiation was 5 h. All infants had moderate or severe hypoxic–ischemic encephalopathy. Mean serum Mg2+ concentration remained at least 1.3 mmol/L. MgSO4 caused no change in physiological variables including mean arterial pressure. Two infants died as neonates, while six of 28 survivors had severe neurodevelopmental disability at 18 months; the remaining 22 had no neurodevelopmental disability.
Conclusion: Postnatal infusion of MgSO4 with dopamine caused no change in physiological variables. Deaths and severe sequelae were less frequent than in reported cases with the same grade of hypoxic–ischemic encephalopathy severity, and this treatment may improve neurodevelopmental outcome in infants with severe birth asphyxia.