American journal of obstetrics & gynecology MFM · 2026
Factors associated with appropriate administration of magnesium sulfate for neuroprotection prior to early preterm birth.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Hendin Natav, Gulersen Moti, Blitz Matthew J, Rochelson Burton, Chervenak Frank A, Bornstein Eran
Аннотация
BACKGROUND: Administration of magnesium sulfate has been shown to provide neuroprotection by reducing the risk of cerebral palsy among surviving neonates with imminent preterm birth prior to 32 weeks' gestation. However, real-world adherence to neuroprotection protocols varies widely.
OBJECTIVE: To evaluate factors associated with appropriate administration of magnesium sulfate for neuroprotection in patients at imminent risk for delivery prior to 32 weeks of gestation.
STUDY DESIGN: A multicenter retrospective cohort included all preterm deliveries between 23⁰⁄₇ and 31⁶⁄₇ weeks' gestation in a large U.S. health system between January 2019 and December 2021. Exclusion criteria included patients with hypertensive disorders of pregnancy, stillbirths, higher-order multiple gestations, and extramural deliveries. Cases were stratified into 2 groups based on whether magnesium was administered prior to the delivery or not. Sociodemographic and obstetric characteristics were compared between groups using Chi-squared or Mann-Whitney U tests. A multivariate logistic regression model identified independent predictors of appropriate administration of neuroprotection with magnesium sulfate.
RESULTS: Of the 527 patients included, 438 (83.1%) received magnesium sulfate prior to delivery. Baseline maternal sociodemographic and obstetric characteristics, including age, race, ethnicity, parity, and insurance type, were not associated with magnesium administration status. Nonadministration of magnesium sulfate prior to delivery occurred more commonly in patients who were admitted for nonreassuring fetal status abnormalities or those with nonobstetric complaints (e.g., medical illness or trauma), and in those who had a significant shorter median time interval from arrival to delivery (1.5 hours vs. 59.0 hours, P<.01). In multivariable analysis, the admission-to-delivery interval was the strongest modifiable predictor of magnesium sulfate administration (aOR: 1.76 per log-hour increase, 95% CI: 1.50-2.04), underscoring time constraints as the primary driver of missed neuroprotection. Lack of adherence to health system protocol for magnesium administration occurred in 16.9% (15/89, 2.8% of overall study cohort) of patients who did not receive magnesium prior to delivery.
CONCLUSIONS: The overall adherence to a protocol of neuroprotection prior to early delivery before 32 weeks of gestation was high. Admission for fetal status abnormalities and nonobstetric complaints were more common among patients who did not receive magnesium prior to delivery, with most patients who did not receive magnesium either arrived within 2 hours before delivery or had an acute change in maternal or fetal status requiring immediate delivery. El resumen está disponible en Español al final del artículo.
OBJECTIVE: To evaluate factors associated with appropriate administration of magnesium sulfate for neuroprotection in patients at imminent risk for delivery prior to 32 weeks of gestation.
STUDY DESIGN: A multicenter retrospective cohort included all preterm deliveries between 23⁰⁄₇ and 31⁶⁄₇ weeks' gestation in a large U.S. health system between January 2019 and December 2021. Exclusion criteria included patients with hypertensive disorders of pregnancy, stillbirths, higher-order multiple gestations, and extramural deliveries. Cases were stratified into 2 groups based on whether magnesium was administered prior to the delivery or not. Sociodemographic and obstetric characteristics were compared between groups using Chi-squared or Mann-Whitney U tests. A multivariate logistic regression model identified independent predictors of appropriate administration of neuroprotection with magnesium sulfate.
RESULTS: Of the 527 patients included, 438 (83.1%) received magnesium sulfate prior to delivery. Baseline maternal sociodemographic and obstetric characteristics, including age, race, ethnicity, parity, and insurance type, were not associated with magnesium administration status. Nonadministration of magnesium sulfate prior to delivery occurred more commonly in patients who were admitted for nonreassuring fetal status abnormalities or those with nonobstetric complaints (e.g., medical illness or trauma), and in those who had a significant shorter median time interval from arrival to delivery (1.5 hours vs. 59.0 hours, P<.01). In multivariable analysis, the admission-to-delivery interval was the strongest modifiable predictor of magnesium sulfate administration (aOR: 1.76 per log-hour increase, 95% CI: 1.50-2.04), underscoring time constraints as the primary driver of missed neuroprotection. Lack of adherence to health system protocol for magnesium administration occurred in 16.9% (15/89, 2.8% of overall study cohort) of patients who did not receive magnesium prior to delivery.
CONCLUSIONS: The overall adherence to a protocol of neuroprotection prior to early delivery before 32 weeks of gestation was high. Admission for fetal status abnormalities and nonobstetric complaints were more common among patients who did not receive magnesium prior to delivery, with most patients who did not receive magnesium either arrived within 2 hours before delivery or had an acute change in maternal or fetal status requiring immediate delivery. El resumen está disponible en Español al final del artículo.