Magnesium sulphate given before very-preterm birth to protect infant brain:: the randomised controlled PREMAG trial

Objective To evaluate whether magnesium sulphate (MgSO4) given to women at risk of very-preterm birth would be neuroprotective in preterm newborns and would prevent neonatal mortality and severe white-matter injury (WMI). Design A randomised study. Setting Eighteen French tertiary hospitals. Population Women with fetuses of gestational age < 33 weeks whose birth was planned or expected within 24 hours were enrolled from July 1997 to July 2003 with follow up of infants until hospital discharge. Methods Five hundred and seventy-three mothers were randomly assigned to receive a single 40-ml infusion of 0.1 g/ml of MgSO4 (4 g) solution or isotonic 0.9% saline (placebo) over 30 minutes. This study is registered as an International Standard Randomised Controlled Trial, number 00120588. Main outcome measures The primary endpoints were rates of severe WMI or total mortality before hospital discharge, and their combined outcome. Analyses were based on intention to treat. Results After 6 years of enrolment, the trial was stopped. Data from 688 infants were analysed. Comparing infants who received MgSO4 or placebo, respectively, total mortality (9.4 versus 10.4%; OR: 0.79, 95% CI 0.44-1.44), severe WMI (10.0 versus 11.7%; OR: 0.78, 95% CI 0.47-1.31) and their combined outcomes (16.5 versus 17.9%; OR: 0.86, 95% CI 0.55-1.34) were less frequent for the former, but these differences were not statistically significant. No major maternal adverse effects were observed in the MgSO4 group. Conclusion Although our results are inconclusive, improvements of neonatal outcome obtained with MgSO4 are of potential clinical significance. More research is needed to assess the protective effect of MgSO4 alone or in combination with other neuroprotective molecules.