Magnesium Sulfate Before Preterm Birth for Neuroprotection: An Updated Cochrane Systematic Review.

IF 8.3 2区 材料科学 Q1 MATERIALS SCIENCE, MULTIDISCIPLINARY
ACS Applied Materials & Interfaces Pub Date : 2024-08-01 Epub Date: 2024-06-03 DOI:10.1097/AOG.0000000000005644
Emily S Shepherd, Shona Goldsmith, Lex W Doyle, Philippa Middleton, Stéphane Marret, Dwight J Rouse, Peter Pryde, Hanne T Wolf, Caroline A Crowther
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引用次数: 0

Abstract

Objective: To systematically review the evidence for the effectiveness and safety of magnesium sulfate as a fetal neuroprotective agent when given to individuals at risk of preterm birth.

Data sources: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov , the World Health Organization International Clinical Trials Registry Platform (through March 17, 2023), and reference lists of relevant studies.

Methods of study selection: Randomized controlled trials (RCTs) assessing magnesium sulfate for fetal neuroprotection in pregnant participants at risk of imminent preterm birth were eligible. Two authors assessed RCTs for inclusion, extracted data, and evaluated risk of bias, trustworthiness, and evidence certainty (GRADE [Grading of Recommendations Assessment, Development and Evaluation]).

Tabulation, integration, and results: We included six RCTs (5,917 pregnant participants and 6,759 fetuses at less than 34 weeks of gestation at randomization). They were conducted in high-income countries (two in the United States, two across Australia and New Zealand, and one each in Denmark and France) and commenced between 1995 and 2018. Primary outcomes: up to 2 years of corrected age, magnesium sulfate compared with placebo reduced the risk of cerebral palsy (risk ratio [RR] 0.71, 95% CI, 0.57-0.89; six RCTs, 6,107 children) and death or cerebral palsy (RR 0.87, 95% CI, 0.77-0.98; six RCTs, 6,481 children) (high-certainty evidence). Magnesium sulfate had little or no effect on death up to 2 years of corrected age (moderate-certainty evidence) or these outcomes at school age (low-certainty evidence). Although there was little or no effect on death or cardiac or respiratory arrest for pregnant individuals (low-certainty evidence), magnesium sulfate increased adverse effects severe enough to stop treatment (RR 3.21, 95% CI, 1.88-5.48; three RCTs, 4,736 participants; moderate-certainty evidence). Secondary outcome: magnesium sulfate reduced the risk of severe neonatal intraventricular hemorrhage (moderate-certainty evidence).

Conclusion: Magnesium sulfate for preterm fetal neuroprotection reduces cerebral palsy and death or cerebral palsy for children. Further research is required on longer-term benefits and harms for children, effect variation by participant and treatment characteristics, and the generalizability of findings to low- and middle-income countries.

Systematic review registration: The review protocol was based on a standard Cochrane Pregnancy and Childbirth template and our previous Cochrane Systematic Review (doi: 10.1002/14651858.CD004661.pub3 ; published before the introduction of PROSPERO).

早产儿出生前服用硫酸镁以保护神经:最新 Cochrane 系统综述。
目的系统回顾硫酸镁作为胎儿神经保护剂用于早产风险个体的有效性和安全性的证据:我们检索了Cochrane妊娠与分娩试验登记册、ClinicalTrials.gov、世界卫生组织国际临床试验登记平台(截止到2023年3月17日)以及相关研究的参考文献列表:符合条件的研究均为随机对照试验(RCT),这些试验评估了硫酸镁对面临早产风险的孕妇胎儿神经的保护作用。两位作者对纳入的 RCT 进行了评估,提取了数据,并对偏倚风险、可信度和证据确定性进行了评估(GRADE [Grading of Recommendations Assessment, Development and Evaluation]):我们纳入了六项研究性临床试验(5917 名孕期参与者和 6759 名随机妊娠不足 34 周的胎儿)。这些研究均在高收入国家进行(美国 2 项、澳大利亚和新西兰 2 项、丹麦和法国各 1 项),研究始于 1995 年至 2018 年。主要研究结果:与安慰剂相比,硫酸镁可降低2岁以内患脑瘫(风险比[RR]0.71,95% CI,0.57-0.89;6项RCT,6107名儿童)和死亡或脑瘫(RR 0.87,95% CI,0.77-0.98;6项RCT,6481名儿童)的风险(高确定性证据)。硫酸镁对2岁以内的死亡(中度确定性证据)或学龄期的这些结果(低确定性证据)几乎没有影响。虽然硫酸镁对孕妇的死亡或心脏或呼吸骤停影响很小或没有影响(低度确定性证据),但硫酸镁会增加不良反应,严重到足以停止治疗(RR 3.21,95% CI,1.88-5.48;三项 RCT,4736 名参与者;中度确定性证据)。次要结果:硫酸镁可降低新生儿严重脑室出血的风险(中度确定性证据):结论:硫酸镁用于早产胎儿神经保护可减少脑瘫和儿童死亡或脑瘫。还需要进一步研究对儿童的长期益处和危害、参与者和治疗特征的效果差异以及研究结果在中低收入国家的推广性:综述方案基于标准的 Cochrane 妊娠与分娩模板以及我们之前的 Cochrane 系统综述(doi: 10.1002/14651858.CD004661.pub3;在 PROSPERO 推出之前发表)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
ACS Applied Materials & Interfaces
ACS Applied Materials & Interfaces 工程技术-材料科学:综合
CiteScore
16.00
自引率
6.30%
发文量
4978
审稿时长
1.8 months
期刊介绍: ACS Applied Materials & Interfaces is a leading interdisciplinary journal that brings together chemists, engineers, physicists, and biologists to explore the development and utilization of newly-discovered materials and interfacial processes for specific applications. Our journal has experienced remarkable growth since its establishment in 2009, both in terms of the number of articles published and the impact of the research showcased. We are proud to foster a truly global community, with the majority of published articles originating from outside the United States, reflecting the rapid growth of applied research worldwide.
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