Magnesium sulfate for brain protection in neonatal encephalopathy: a systematic review.

OBJECTIVE

To evaluate the safety and efficacy of postnatal magnesium sulfate (MgSO₄) for neuroprotection in neonates with neonatal encephalopathy (NE).

STUDY

DESIGN

Systematic review and meta-analysis of controlled clinical trials assessing MgSO₄ administered within 12 h of birth in term or near-term infants with NE. Databases searched included MEDLINE, Embase, and Cochrane sources.

RESULTS

Twenty-four trials were included. MgSO₄ was consistently safe, with no significant adverse hemodynamic or respiratory effects. Meta-analyses demonstrated improved short-term outcomes, including reduced seizure occurrence, improved neurological status at discharge, and earlier establishment of feeding. No significant reduction in mortality was observed. Evidence regarding long-term neurodevelopmental outcomes was extremely limited. Most pre-therapeutic hypothermia studies demonstrated favorable short-term neurological or clinical outcomes. Studies conducted alongside therapeutic hypothermia have not reported long-term outcomes.

CONCLUSION

Postnatal MgSO₄ is safe and associated with improved short-term clinical outcomes in neonates with NE. However, absence of long-term benefit and limited evidence in the era of therapeutic hypothermia preclude routine clinical use.