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Intrapartum magnesium sulfate and need for intensive delivery room resuscitation
  1. Dany E Weisz1,
  2. Sandesh Shivananda2,
  3. Elizabeth Asztalos1,3,
  4. Wendy Yee4,
  5. Anne Synnes5,
  6. Shoo K Lee3,
  7. Prakesh S Shah3,6
  8. on behalf of the Canadian Neonatal Network
  1. 1Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Canada
  2. 2Department of Paediatrics, McMaster Children's Hospital, Hamilton, Canada
  3. 3Department of Paediatrics, University of Toronto, Toronto, Canada
  4. 4Department of Paediatrics, University of Calgary, Calgary, Canada
  5. 5Department of Paediatrics, University of British Columbia, Vancouver, Canada
  6. 6Institute of HPME, University of Toronto, Toronto, Canada
  1. Correspondence to Dr Prakesh S Shah, Department of Paediatrics, University of Toronto, Staff Neonatologist, Mount Sinai Hospital, 775A- 600 University Avenue, Toronto, Ontario, Canada M5G 1X5; pshah{at}


Objective To evaluate the association of intrapartum magnesium sulfate for fetal neuroprotection (MgSO4-FN) with the delivery room resuscitation and neonatal outcomes of preterm infants in an era of minimisation of invasive mechanical ventilation.

Design Retrospective cohort study.

Setting Neonatal intensive care units in the Canadian Neonatal Network.

Patients and intervention Preterm infants (230 to 316 weeks gestational age) born in 2011 or 2012. Resuscitation requirements and neonatal outcomes were compared between infants exposed and unexposed to intrapartum MgSO4-FN.

Main outcome measures The primary outcome was a composite outcome of ‘intensive resuscitation’, defined as the need for intubation and ventilation or chest compressions or epinephrine administration in the delivery room. Secondary outcomes included mortality and major neonatal morbidities.

Results Of 6015 eligible infants, 1387 (23.1%) were exposed to intrapartum MgSO4-FN. Significantly fewer MgSO4-FN infants (41.0% vs 44.6%, p=0.02) required intensive resuscitation. However, after adjustment for confounders, this difference was no longer significant (adjusted OR (AOR) 0.88; 95% CI 0.66 to 1.17). Infants exposed to MgSO4-FN had decreased odds of death (AOR 0.61; 95% CI 0.40 to 0.94), but there was no difference in neonatal morbidities compared with the unexposed infants.

Conclusions Intrapartum MgSO4 for fetal neuroprotection was not associated with an increased need for intensive delivery room resuscitation in this cohort of preterm infants.

  • Neonatology
  • Neurodevelopment
  • Outcomes research
  • Resuscitation
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