magnesium sulfate in

prevention of intraventricular
hemorrhage in premature
infants
Jane Laura
3 jurnal
• The survey of magnesium sulfate in prevention of intraventricular
hemorrhage in premature infants: a randomized clinical trial
(Shayesth Parashi, et al)
• Effect of antenatal administration of magnesium sulphate and milking
of umbilical cord during delivery on the incidence of intraventricular
haemorrhage in preterm infants (Stephy Maria Tom, V.C. Manoj)
• A review of the role for magnesium sulphate in preterm labour (
Robert Mittendorf, Peter G. Pryde)
background
• IVH sering terjadi pada premature dan bayi dengan berat badan lahir
rendah.
• IVH bisa menyebabkan prolonged disability : cerebral palsy, mental
retardation, seizure, behavioral and cognitive problems, dan kematian
• Symptokps IVH tergantung pada keparahannya.
• Pada akut dan severe: sudden change to bad status, severe sudden
pale skin, acute anemia, respiratoey disorder, and fontanel bulging
• Brain USG atau magnetic resonance imaging is used in the first three
days of life dan pada suspected cases, dapat diulang 2-3 kali.
Grade IVH
• 1. limited bleeding to germinal matrix
• 2. intraventricular hemorrhage
• 3. bleeding with ventricular hemorrhage
• 4. extension of bleeding to brain parenchyma
• Treatment of mothers with magnesium sulfate would result in
myocardial stability and blood supply in placenta and fetal brain, and
reduction of ischemic region, and anti-oxidant effects with decreased
platelet adhesion are neuroprotective in fetus.
Methods
• 120 PROM 34 minggu
• 60 : IV magnesium sulfate (6g 20-30 mnt  2g setiap jam selama
12 jam sebelum melahirkan)
• 60 : placebo (control)
• 80 pregnant women less than 33 weeks
• 25  magnesium sulfate yang dicurigai akan early preterm birth ( 4
gm 100ml normal saline 20-30mnt  4gm in 100ml over 4 hours at
1gm/hr)
• 14 milking umbilica; cord
• 2 milking dan magnesium sulfate
• 39 preterm tidak diapa-apakan
• 144 neonates cranial usg
• 1,2,4 weeks of life
results
• 120 PROM 34 minggu
• 60 : IV magnesium sulfate (6g 20-30 mnt  2g
setiap jam selama 12 jam sebelum melahirkan)
• 60 : placebo (control)
• IVH rate: 5%  intervention, 16% control
• Milking+ magnesium sulfate : 0
• 1 received magnesium sulfate  IVH
• 3 infants with no magnesium sulfate developed IVH
• 24 IVH, mean maternal venous serum iMg level: 0,75mmol/L
• Non IVH 0,56mmol/L
• 3 grade 3: 1,00
• IVH grade 1 : 0,67mmol/L
discussion
• The magnesium sulfate would result in decreased IVH rate but it is
controversial
• Since IVH in every grade is a risk factor for long term neuropathy, the
role of magnesium sulfate should assessed
• On the first jurnal IVH was not differed between the two groups
comprising neonates receiving and not receiving magnesium sulfate
• This may due to different design, sample size, or follow up patterns
• Duetoantiarrythmia, neuroprotective effects, and ischemia reduction,
the significant effect on IVH was expected
conclusion
• Antenatal magnesium sulfate and milking of umbilical cord resulted in
a significant reduction on the incidence of IVH
• Magnesium sulfate may prevent the incidence of IVH
• Further analysis needed