产前硫酸镁用于早产儿神经保护:科威特第三重症监护病房的单中心经验。

Biomedicine Hub Pub Date : 2022-06-30 eCollection Date: 2022-05-01 DOI:10.1159/000525431
Mariam Ayed, Javed Ahmed, Kiran More, Amal Ayed, Hamid Husain, Ammar AlQurashi, Najla Alrajaan
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引用次数: 3

摘要

目的:本研究旨在评估产前暴露硫酸镁(MgSO4)对妊娠少于32周的早产儿短期和长期结局的影响。方法:2018年1月至2018年12月,在科威特一家三级新生儿护理病房对229名妊娠24至32周的新生儿进行单中心回顾性队列研究。从医疗记录中收集产前MgSO4暴露,指征为神经保护作用。对212名新生儿(中位胎龄36周)进行脑MRI检查,并用米勒评分评估脑损伤。采用Bayley-III矫正年龄36个月婴儿发育量表评估神经发育结局(N = 146)。通过多变量回归分析,调整MRI孕龄和p值变量,研究MgSO4暴露与脑损伤和神经发育结局的关系。结果:229例新生儿中,47例产前接受了MgSO4。两组之间的胎龄和出生体重没有差异。MgSO4暴露与坏死性小肠结肠炎、慢性肺病、早产儿视网膜病变和死亡率的风险增加无关。MgSO4组小脑出血发生率明显降低(0% vs. 16%, p值= 0.002)。接受MgSO4治疗的新生儿发生3-4级脑室内出血(IVH)的风险较低,调整OR为0.248 (95% CI: 0.092, 0.66), p = 0.006;中重度白质损伤(WMI)调整奇比0.208 (95% CI: 0.044, 0.96), p = 0.046;3-4级IVH和/或中重度WMI调整or为0.23 (95% CI: 0.06, 0.84), p = 0.027。矫正年龄36月龄时的神经发育评估显示运动能力较好(校正β系数1.08 [95% CI: 0.099, 2.06];p = 0.031)和认知综合评分(校正贝塔系数1.29 [95% CI: 0.36, 2.22];p = 0.007)。结论:小于32周的早产儿产前暴露于MgSO4与较低的脑损伤风险和较好的运动和认知预后独立相关。
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Antenatal Magnesium Sulfate for Preterm Neuroprotection: A Single-Center Experience from Kuwait Tertiary NICU.

Objectives: The study aimed to evaluate the impact of antenatal exposure of magnesium sulfate (MgSO4) on short- and long-term outcomes in preterm neonates born less than 32 weeks gestation.

Methods: Single-center retrospective cohort study of 229 neonates born between 24 and 32 weeks gestation was conducted from January 2018 through December 2018 in a level III neonatal care unit in Kuwait. Antenatal MgSO4 exposure was collected from the medical records, and the indication was for neuroprotection effect. Brain MRI was done on 212 neonates (median gestational age 36 weeks), and brain injury was assessed using the Miller's score. Neurodevelopmental outcome was assessed by Bayley-III scales of infant development at 36 months corrected age (N = 146). The association of exposure to MgSO4 with brain injury and neurodevelopmental outcomes was examined using multivariable regression analysis adjusting for gestational age at MRI and variables with p value <0.05 on univariate analysis.

Results: Among the 229 neonates, 47 received antenatal MgSO4. There were no differences between the groups in gestational age and birth weight. MgSO4 exposure was not associated with an increased risk of necrotizing enterocolitis, chronic lung disease, retinopathy of prematurity, and mortality. The incidence of cerebellar hemorrhage was significantly less in the MgSO4 group (0% vs. 16%, p value = 0.002). Neonates who received MgSO4 had lower risks of grade 3-4 intraventricular hemorrhage (IVH) adjusted OR 0.248 (95% CI: 0.092, 0.66), p = 0.006; moderate-severe white matter injury (WMI) adjusted odd ratio 0.208 (95% CI: 0.044, 0.96), p = 0.046; and grade 3-4 IVH and/or moderate-severe WMI adjusted OR 0.23 (95% CI: 0.06, 0.84), p = 0.027. Neurodevelopmental assessment at 36 months corrected age showed better motor (adjusted beta coefficient 1.08 [95% CI: 0.099, 2.06]; p = 0.031) and cognitive composite scores (adjusted beta coefficient 1.29 [95% CI: 0.36, 2.22]; p = 0.007) in the MgSO4 group.

Conclusion: Antenatal exposure to MgSO4 in preterm neonates less than 32 weeks was independently associated with lower risks of brain injury and better motor and cognitive outcomes.

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