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Am J Perinatol 2015; 32(11): 1064-1069
DOI: 10.1055/s-0035-1548541
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effects of Antenatal Magnesium Exposure on Intestinal Blood Flow and Outcome in Preterm Neonates

Tugba Gursoy
1   Neonatal Intensive Care Unit, Department of Pediatrics, Koc University School of Medicine, Istanbul, Turkey
,
Ebru Yalin Imamoglu
2   Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
,
Fahri Ovali
2   Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
,
Guner Karatekin
2   Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

02 November 2014

03 February 2015

Publication Date:
31 March 2015 (online)

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Abstract

Objective This study aims to investigate the effects of antenatal magnesium sulfate on intestinal blood flow in preterm neonates.

Study Design In this prospective case–match study, 25 preterm neonates exposed to magnesium sulfate antenatally were included (study group). Overall, 25 gestational age–matched neonates who had no exposure to magnesium constituted the control group. Serial daily Doppler flow measurements of superior mesenteric artery (SMA) were performed. The time to reach full feeds, first meconium passage were assessed. Presence of feeding intolerance or necrotizing enterocolitis was recorded.

Results Blood flow velocities of SMA were not different between the groups during the first five postnatal days. However, SMA blood flow showed an increasing trend in the control group unlike the study group (control group, p < 0.001; study group, p = 0.29). There was no significant difference between the two groups regarding the time to reach full feeds or first meconium passage and presence of feeding intolerance. No case of necrotizing enterocolitis was seen.

Conclusion Antenatal magnesium does not significantly affect intestinal blood flow, but it seems to attenuate the increasing trend of the intestinal blood flow in the early postnatal days. However, this study failed to show any impact of this finding on clinical outcomes.

Keywords

blood flow - doppler ultrasound - magnesium - superior mesenteric artery - preterm infant
 

  • References

  • 1 Paradisis M, Osborn DA, Evans N, Kluckow M. Randomized controlled trial of magnesium sulfate in women at risk of preterm delivery-neonatal cardiovascular effects. J Perinatol 2012; 32 (9) 665-670
    CrossrefPubMedGoogle Scholar
  • 2 Shokry M, Elsedfy GO, Bassiouny MM, Anmin M, Abozid H. Effects of antenatal magnesium sulfate therapy on cerebral and systemic hemodynamics in preterm newborns. Acta Obstet Gynecol Scand 2010; 89 (6) 801-806
    CrossrefPubMedGoogle Scholar
  • 3 del moral T, Gonzalez-Quintero VH, Claure N, Vanbuskirk S, Bancalari E. Antenatal exposure to magnesium sulfate and the incidence of patent ductus arteriosus in extremely low birth weight infants. J Perinatol 2007; 27 (3) 154-157
    CrossrefPubMedGoogle Scholar
  • 4 Katayama Y, Minami H, Enomoto M, Takano T, Hayashi S, Lee YK. Antenatal magnesium sulfate and the postnatal response of the ductus arteriosus to indomethacin in extremely preterm neonates. J Perinatol 2011; 31 (1) 21-24
    CrossrefPubMedGoogle Scholar
  • 5 Elimian A, Verma R, Ogburn P, Wiencek V, Spitzer A, Quirk JG. Magnesium sulfate and neonatal outcomes of preterm neonates. J Matern Fetal Neonatal Med 2002; 12 (2) 118-122
    CrossrefPubMedGoogle Scholar
  • 6 Rouse DJ, Hirtz DG, Thom E , et al; Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med 2008; 359 (9) 895-905
    CrossrefPubMedGoogle Scholar
  • 7 Rantonen T, Kääpä P, Grönlund J , et al. Maternal magnesium sulfate treatment is associated with reduced brain-blood flow perfusion in preterm infants. Crit Care Med 2001; 29 (7) 1460-1465
    CrossrefPubMedGoogle Scholar
  • 8 Robel-Tillig E, Knüpfer M, Pulzer F, Vogtmann C. Blood flow parameters of the superior mesenteric artery as an early predictor of intestinal dysmotility in preterm infants. Pediatr Radiol 2004; 34 (12) 958-962
    CrossrefPubMedGoogle Scholar
  • 9 Leidig E. Doppler analysis of superior mesenteric artery blood flow in preterm infants. Arch Dis Child 1989; 64 (4 Spec No) 476-480
    CrossrefPubMedGoogle Scholar
  • 10 Havranek T, Ashmeade TL, Afanador M, Carver JD. Effects of maternal magnesium sulfate administration on intestinal blood flow velocity in preterm neonates. Neonatology 2011; 100 (1) 44-49
    CrossrefPubMedGoogle Scholar
  • 11 Pezzati M, Dani C, Biadaioli R , et al. Early postnatal doppler assessment of cerebral blood flow velocity in healthy preterm and term infants. Dev Med Child Neurol 2002; 44 (11) 745-752
    PubMedGoogle Scholar
  • 12 Dangman BC, Rosen TS. Magnesium levels in infants of mothers treated with MgSO4. Pediatr Res 1977; 11: 415 (abstract 262)
    PubMedGoogle Scholar
  • 13 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
    CrossrefPubMedGoogle Scholar
  • 14 Su BH, Watanabe T, Shimizu M, Yanagisawa M. Echocardiographic assessment of patent ductus arteriosus shunt flow pattern in premature infants. Arch Dis Child Fetal Neonatal Ed 1997; 77 (1) F36-F40
    CrossrefPubMedGoogle Scholar
  • 15 Belfort MA, Saade GR, Moise Jr KJ. The effect of magnesium sulfate on maternal and fetal blood flow in pregnancy-induced hypertension. Acta Obstet Gynecol Scand 1993; 72 (7) 526-530
    CrossrefPubMedGoogle Scholar
  • 16 Altura BT, Altura BM. Withdrawal of magnesium causes vasospasm while elevated magnesium produces relaxation of tone in cerebral arteries. Neurosci Lett 1980; 20 (3) 323-327
    CrossrefPubMedGoogle Scholar
  • 17 Euser AG, Cipolla MJ. Resistance artery vasodilation to magnesium sulfate during pregnancy and the postpartum state. Am J Physiol Heart Circ Physiol 2005; 288 (4) H1521-H1525
    CrossrefPubMedGoogle Scholar
  • 18 Van Bel F, Van Zwieten PH, Guit GL, Schipper J. Superior mesenteric artery blood flow velocity and estimated volume flow: duplex Doppler US study of preterm and term neonates. Radiology 1990; 174 (1) 165-169
    CrossrefPubMedGoogle Scholar
  • 19 Ghidini A, Espada RA, Spong CY. Does exposure to magnesium sulfate in utero decrease the risk of necrotizing enterocolitis in premature infants?. Acta Obstet Gynecol Scand 2001; 80 (2) 126-129
    CrossrefPubMedGoogle Scholar
  • 20 Emil S, Nguyen T, Sills J, Padilla G. Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management. J Pediatr Surg 2004; 39 (5) 731-737
    CrossrefPubMedGoogle Scholar
  • 21 Brazy JE, Grimm JK, Little VA. Neonatal manifestations of severe maternal hypertension occurring before the thirty-sixth week of pregnancy. J Pediatr 1982; 100 (2) 265-271
    CrossrefPubMedGoogle Scholar
  • 22 Kumar SL, Dhanireddy R. Time of first stool in premature infants: effect of gestational age and illness severity. J Pediatr 1995; 127 (6) 971-974
    CrossrefPubMedGoogle Scholar
  • 23 Verma A, Dhanireddy R. Time of first stool in extremely low birth weight (< or = 1000 grams) infants. J Pediatr 1993; 122 (4) 626-629
    CrossrefPubMedGoogle Scholar
  • 24 Fang S, Kempley ST, Gamsu HR. Prediction of early tolerance to enteral feeding in preterm infants by measurement of superior mesenteric artery blood flow velocity. Arch Dis Child Fetal Neonatal Ed 2001; 85 (1) F42-F45
    CrossrefPubMedGoogle Scholar
  • 25 Thwaites CL, Yen LM, Loan HT , et al. Magnesium sulphate for treatment of severe tetanus: a randomised controlled trial. Lancet 2006; 368 (9545) 1436-1443
    CrossrefPubMedGoogle Scholar
  • 26 Geboes KP, Maes B, Luypaerts A , et al. Magnesium chloride slows gastric emptying, but does not affect digestive functions. Aliment Pharmacol Ther 2002; 16 (8) 1571-1577
    CrossrefPubMedGoogle Scholar
  • 27 Izzo AA, Gaginella TS, Mascolo N, Capasso F. Nitric oxide as a mediator of the laxative action of magnesium sulphate. Br J Pharmacol 1994; 113 (1) 228-232
    CrossrefPubMedGoogle Scholar