{"title":"Effect of Antenatal Magnesium Sulfate Exposure on Patent Ductus Arteriosus in Premature Infants.","authors":"Emel Okulu, Elvis Kraja, Yasemin Ezgi Kostekci, Erdal Seker, Mehmet Seckin Ozisik, Doğacan Sarısoy, Batuhan Aslan, Maide Selin Çakır, Ferhan Demirtaş, Mehmet Gökhan Ramoğlu, Tayfun Uçar, Omer Erdeve, Begum Atasay, Acar Koc, Saadet Arsan","doi":"10.1055/s-0044-1779620","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong> Magnesium sulfate (MgSO<sub>4</sub>) provides effective fetal neuroprotection. However, there is conflicting evidence regarding the association between antenatal MgSO<sub>4</sub> exposure and patent ductus arteriosus (PDA). Thus, herein, we aimed to evaluate the association between antenatal MgSO<sub>4</sub> exposure and PDA.</p><p><strong>Study design: </strong> Preterm infants born between 24<sup>0/7</sup> and 31<sup>6/7</sup> weeks of gestation were included in this retrospective study. Infants who died within the first 72 hours of life and those with significant congenital anomalies were excluded from the study. Echocardiographic and clinical assessment parameters were used to define PDA and hemodynamically significant PDA (hsPDA). Treatments were planned according to the standard protocols of the unit. The following data were collected from hospital medical records: perinatal characteristics, neonatal outcomes, detailed PDA follow-up findings, and maternal characteristics including MgSO<sub>4</sub> exposure and doses.</p><p><strong>Results: </strong> Of the 300 included infants, 98 (32.6%) were exposed to antenatal MgSO<sub>4</sub>. hsPDA rates were similar in the infants exposed and not exposed to antenatal MgSO<sub>4</sub>, when adjusted for antenatal steroid administration, gestational age, and birth weight (OR: 1.6, 95% CI: 0.849-3.118, <i>p</i> = 0.146). The rates of PDA ligation and open PDA at discharge were similar between the groups. A cumulative MgSO<sub>4</sub> dose of >20 g was associated with an increased risk of hsPDA (crude OR: 2.476, 95% CI: 0.893-6.864, <i>p</i> = 0.076; adjusted OR: 3.829, 95% CI: 1.068-13.728, <i>p</i> = 0.039). However, the cumulative dose had no effect on the rates of PDA ligation or open PDA at discharge. Rates of prematurity-related morbidities and mortality were similar between the groups.</p><p><strong>Conclusion: </strong> Although antenatal MgSO<sub>4</sub> exposure may increase the incidence of hsPDA, it may not affect the rates of PDA ligation or open PDA at discharge. Further studies are required to better evaluate the dose-dependent outcomes and identify the MgSO<sub>4</sub> dose that not only provides neuroprotection but also has the lowest risk of adverse effects.</p><p><strong>Key points: </strong>· Antenatal exposure of MgSO4 may cause PDA.. · Antenatal MgSO4 exposure may not increase the rates of PDA ligation or open PDA at discharge.. · Further studies are required to better evaluate the dose-dependent outcomes and optimal MgSO4 dose..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of perinatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/s-0044-1779620","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/6 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Magnesium sulfate (MgSO4) provides effective fetal neuroprotection. However, there is conflicting evidence regarding the association between antenatal MgSO4 exposure and patent ductus arteriosus (PDA). Thus, herein, we aimed to evaluate the association between antenatal MgSO4 exposure and PDA.
Study design: Preterm infants born between 240/7 and 316/7 weeks of gestation were included in this retrospective study. Infants who died within the first 72 hours of life and those with significant congenital anomalies were excluded from the study. Echocardiographic and clinical assessment parameters were used to define PDA and hemodynamically significant PDA (hsPDA). Treatments were planned according to the standard protocols of the unit. The following data were collected from hospital medical records: perinatal characteristics, neonatal outcomes, detailed PDA follow-up findings, and maternal characteristics including MgSO4 exposure and doses.
Results: Of the 300 included infants, 98 (32.6%) were exposed to antenatal MgSO4. hsPDA rates were similar in the infants exposed and not exposed to antenatal MgSO4, when adjusted for antenatal steroid administration, gestational age, and birth weight (OR: 1.6, 95% CI: 0.849-3.118, p = 0.146). The rates of PDA ligation and open PDA at discharge were similar between the groups. A cumulative MgSO4 dose of >20 g was associated with an increased risk of hsPDA (crude OR: 2.476, 95% CI: 0.893-6.864, p = 0.076; adjusted OR: 3.829, 95% CI: 1.068-13.728, p = 0.039). However, the cumulative dose had no effect on the rates of PDA ligation or open PDA at discharge. Rates of prematurity-related morbidities and mortality were similar between the groups.
Conclusion: Although antenatal MgSO4 exposure may increase the incidence of hsPDA, it may not affect the rates of PDA ligation or open PDA at discharge. Further studies are required to better evaluate the dose-dependent outcomes and identify the MgSO4 dose that not only provides neuroprotection but also has the lowest risk of adverse effects.
Key points: · Antenatal exposure of MgSO4 may cause PDA.. · Antenatal MgSO4 exposure may not increase the rates of PDA ligation or open PDA at discharge.. · Further studies are required to better evaluate the dose-dependent outcomes and optimal MgSO4 dose..
期刊介绍:
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.