Effect of Magnesium Sulfate "MgSO4" Therapy in Preterm Deliveries, Bolus versus Bolus and Infusion Protocols on Apgar score: Randomized Clinical Trial (RCT)

Abstract

P reterm birth can be considered a complex problem in relation to baby's development to the parents' practical and emotional experience and to mother child interaction. The poor developmental outcomes of preterm infants have been well documented. Protection of the immature brain of premature infants constitutes a crucial challenge for obstetricians and neonatologists. Preterm birth is a risk factor for cerebral palsy (C.P.), a condition characterized by abnormal control of movement and posture that results in limitation of activity. Although the survival of premature infants is continuously improving, their neurological outcome remains a major concern, as preterm birth is associated with neuro-developmental impairments such as neuromotor deficits, cognitive deficits, learning disabilities, behavioral and psychiatric disorders and neurosensory deficiencies. Currently, one third of cases of cerebral palsy (C.P.) are associated with early preterm birth. Almost 40% of individuals with C.P. were born preterm and the risk of C.P. increases with decreasing gestational age. Although survival rates of babies born preterm have risen, there has been no parallel fall in neuro-developmental impairment rates, especially among babies born very preterm at < 32 weeks’ gestation. Magnesium is an ionized mineral essential to hundreds of enzymatic processes, including hormone receptor binding, energy metabolism, muscle contractility as well as neuronal and neurotransmitter function. It is primarily an intracellular cation, and stores are distributed between bone (53%), muscle (27%), and soft tissue (19%). Serum magnesium levels are tightly controlled (0.65–1.05 mmol/L), and homeostasis is maintained through intestinal absorption, storage in bones, and renal excretion.