Neonatal magnesium sulphate for neuroprotection: A systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#humans #magnesium-sulfate #neuroprotective-agents #infant-newborn #asphyxia-neonatorum

Neonatal magnesium sulphate for neuroprotection: A systematic review and meta-analysis

Shepherd et al., 2024 | Dev Med Child Neurol | Meta Analysis

Citation

Shepherd Emily, Karim Tasneem, ... Galinsky Robert. Neonatal magnesium sulphate for neuroprotection: A systematic review and meta-analysis. Dev Med Child Neurol. 2024-Sep;66(9):1157-1172. doi:10.1111/dmcn.15899

Abstract

AIM: To review the evidence of the effects of neonatal magnesium sulphate for neuroprotection in perinatal asphyxia and hypoxic-ischaemic encephalopathy (HIE). METHOD: This was a systematic review of randomized controlled trials (RCTs) (with meta-analysis) and non-RCTs assessing magnesium sulphate for treating perinatal asphyxia and HIE at 35 weeks or more gestation (primary outcomes: neonatal death and death or long-term major neurodevelopmental disability). RESULTS: Twenty-five RCTs (2099 infants) and four non-RCTs (871 infants) were included, 23 in low- and middle-income countries (LMICs). In RCTs, reductions in neonatal death with magnesium sulphate versus placebo or no treatment (risk ratio [RR] = 0.68; 95% confidence interval [CI] = 0.53-0.86; 13 RCTs), and magnesium sulphate with melatonin versus melatonin alone (RR = 0.74; 95% CI = 0.58-0.95; one RCT) were observed. No difference in neonatal death was seen for magnesium sulphate with therapeutic hypothermia versus therapeutic hypothermia alone (RR = 0.66, 95% CI = 0.34-1.26; three RCTs), or magnesium sulphate versus phenobarbital (RR = 3.00; 95% CI = 0.86-10.46; one RCT). No reduction in death or long-term neurodevelopmental disability (RR = 0.52; 95% CI = 0.14-1.89; one RCT) but reductions in several short-term adverse outcomes were observed with magnesium sulphate. Evidence was low- to very-low certainty because of risk of bias and imprecision. INTERPRETATION: Given the uncertainty of the current evidence, further robust neonatal magnesium sulphate research is justified. This may include high-quality studies to determine stand-alone effects in LMICs and effects with and after therapeutic hypothermia in high-income countries.

Key Findings

Twenty-five RCTs (2099 infants) and four non-RCTs (871 infants) were included, 23 in low- and middle-income countries (LMICs). In RCTs, reductions in neonatal death with magnesium sulphate versus placebo or no treatment (risk ratio [RR] = 0.68; 95% confidence interval [CI] = 0.53-0.86; 13 RCTs), and magnesium sulphate with melatonin versus melatonin alone (RR = 0.74; 95% CI = 0.58-0.95; one RCT) were observed. No difference in neonatal death was seen for magnesium sulphate with therapeutic hypot

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 13
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Magnesium Sulfate
  • Neuroprotective Agents
  • Infant, Newborn
  • Asphyxia Neonatorum
  • Hypoxia-Ischemia, Brain
  • Randomized Controlled Trials as Topic
  • Hypothermia, Induced

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Systematic Review, Journal Article, Meta-Analysis
  • Vertical: magnesium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09