69 - Antenatal magnesium sulfate exposure and gastrointestinal outcomes in preterm infants - A systematic review and meta-analysis.

Poster Number: 69
Publication Number: 69.235

Arun Prasath, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Nell Aronoff, University at Buffalo, Buffalo, NY, United States; Praveen Chandrasekharan, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, United States; Shivashankar Diggikar, Oyster Woman and Child Hospital, Bengaluru, Karnataka, India

Background: Magnesium sulfate (MgS04) has been used in pregnant women for neuroprotection, preeclampsia, tocolysis.

Objective:

To evaluate the effect of maternal MgSo4 on the preterm infants gastrointestinal (GI) system.

 

Design/Methods:

A systematic literature search was conducted using PubMed, CINAHL, Embase , and CENTRAL (Ovid) in Nov'22. There were 6,695 references. After deduplication, 4,332 remained. Randomized or quasi-randomized clinical trials and observational studies with pre-specified outcomes were included. Preterm infants whose mothers were given antenatal MgSo4 were included and mothers who did not receive antenatal MgSo4 were considered as comparators. Preterm infants with congenital anomalies were excluded. A random-effects model meta-analysis was performed using Review Manager V.5.3 (Cochrane Collaboration, Nordic Cochrane Center, Copenhagen, Denmark) to yield pooled OR and its 95% CI for each outcome due to expected heterogeneity in the studies. The analysis for each predefined outcome was performed separately for adjusted and unadjusted comparisons. All included studies were assessed for methodological quality. The risk of bias was assessed using elements of the Cochrane Collaboration tool 2.0 & Newcastle-Ottawa’s scale for RCT’s and non-randomized studies respectively. This study is reported according to the PRISMA guidelines and was registered in PROSPERO (CRD4202236746) 
Main Outcomes and Measures: Necrotizing enterocolitis (NEC)(stage >/=2), surgical NEC, spontaneous intestinal perforation (SIP), feeding intolerance, & GI-associated mortality.

 

 

Results:

 

A total of 4,332 studies were identified, 81 full texts were assessed, and 30 studies (24 observational and 6 RCT’s) with 39,950 preterm infants were included in final analysis. There were no increased odds of GI associated mortality (n-200, OR: 0.65(95% CI, 0.16-2.65)), stage >/=2 NEC (n-39,950, OR: 0.91 (95% CI, 0.76-1.10)),Surgical NEC( n-29,506, OR: 0.74 (95% CI, 0.62-0.90) ARR **%, NNT=**), SIP (n -29582, OR:1.40, 95% CI 0.82-2.38)), or feed intolerance (n-134, OR: 1.47(95% CI, 0.37-5.91)) in infants exposed to antenatal MgSo4.On the contrary, the incidence of surgical NEC was significantly lower in Mgso4 exposure infants (n-29,506, OR:0.74 (95% CI, 0.62-0.90)).


Conclusion(s):

In our meta-analysis Antenatal Mgso4 did not increase the incidence of GI-related morbidities or mortality in preterm infants. However, most of the studies were observational and heterogenous. These characteristics and the non-uniformity of dose and indications of the use of magnesium sulfate were limitations of the study.