If Mothers Only Knew – Revisited

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This field is for validation purposes and should be left unchanged. also reports on the trial confirming the neuro protective effect of magnesium sulfate I earlier discussed in “If Mothers Only Knew.”  This report misses the point that many physicians still think the standard of practice still does not require that magnesium sulfate be administered to mothers threatening preterm delivery prior to 32 weeks.   Rouse was the lead author for the published study findings reports.  However, Rouse wrote an opinion piece in the same issue of the New England Journal of Medicine lamenting that the beneficial effects of magnesium sulfate have not,  for some authorities,  been sufficiently established to recommend its use.  Rouse opines that the neuroprotective effects of magnesium sulfate could spare 1000 children a year from suffering cerebral palsy.

The first study to demonstrate the beneficial effects of magnesium in this setting was published in 1995.  The Rouse trial first reported upon in 2008 was the largest to date and those findings were again confirmed by Constantine and Weiner in their impressive meta-analysis “Effects of Antenatal Exposure to Magnesium Sulfate on Neuroprotection and Mortality in Preterm Infants” (Obstet Gynecol 2009; 114:354-64).

Weiner and Constantine, though concluding “magnesium sulfate…significantly reduces the risk of cerebral palsy without increasing the risk of death,” still fall short of insisting upon its use.   This vacillation evades the the kind of pronouncement that assures obstetricians of the need to change their practices.

How many further children must needlessly suffer until a new standard of practice is pronounced?  I think a new standard of practice has been announced and if obstetricians choose otherwise and cerebral palsy results,  those obstetricians will suffer consequences.

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