Postnatal Preventive Effect of Magnesium Sulfate on Intraventricular Hemorrhage of Preterm Infants

Document Type: Original Article


1 Neonatal Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Background: Germinal matrix hemorrhage and intraventricular hemorrhage (GMH-IVH) are among the causes of morbidity and mortality in very low birth weight (VLBW) neonates. The aim of this study was to determine the postnatal prophylactic effect of magnesium sulfate on GMH-IVH.
Methods: In this double-blind clinical trial, 140 VLBW newborns were selected. The babies with birth weight ≤ 1500 g and gestational age ≤ 32 weeks were included. The babies with major malformation, infection, hemostatic disorders, severe cardio-respiratory failure, as well as asphyxia and resuscitation in the delivery room were excluded. They were randomly divided into two groups using a coin. The case group received 50% magnesium sulfate 4 mg/kg/day as a single dose via intravenous injection over 15-20 min for 3 days. All babies had a head ultrasound (HUS) in 24 to 48 h after birth, and if it was normal they were included in the study. The HUS was repeated in 1, 2, and 3 weeks after birth by a radiologist who did not know about the intervention. The control group received placebo sterile water in a dose similar to magnesium sulfate. The magnesium level was measured on day 4 at the end of the treatment.
Results: Although GMH-IVH was two times more in the control group, the difference was not statistically significant between the two groups (P>0.05). The difference in the grading of IVH was not also significant between the two groups (P=0.25). The level of magnesium sulfate was significantly higher in the case group (P=0.04).
Conclusion: The results of this study showed that the postnatal administration of magnesium sulfate has no effect on the prevention of IVH.


1. Saeidi R, Izanloo A. Probiotics and retinopathy of premature: systemic review: P449. Arch Dis Childhood. 2019; 104:A1-428.
2. Chevallier M, Debillon T, Pierrat V, Delorme P, Kayem G, Durox M, et al. Leading causes of preterm delivery as risk factors for intraventricular hemorrhage in very preterm infants: results of the EPIPAGE 2 cohort study. Am J Obstetr Gynecol. 2017; 216(5):518.e1-12.
3. Vries LS. Intracranial hemorrhage and vascular lesions. Fanaroff and Martin’s neonatal-perinatal medicine. 10th ed. St Lois: Mosby. 2015.
4. Shafik AN, Khattab MA, Osman AH. Magnesium sulfate versus esomeprazole impact on the neonates of preeclamptic rats. Eur J Obstet Gynecol Reprod Biol. 2018; 225:236-42.
5. Ballard J, Khoury JC, Wedig KL, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr. 1991; 119(3):417-23.
6. Volpe JJ. Intracranial hemorrhage: germinal matrix - intraventricular hemorrhage of the premature infant. Neurology of the newborn. 5th ed. Philadelphia: Saunders Elsevier; 2008.
7. McCrea HJ, Ment LR. The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate. Clin Perinatol. 2008; 35(4):777-92.
8. Smit E, Odd D, Whitelaw A. Postnatal phenobarbital for the prevention of intraventricular haemorrhage in preterm infants. Cochrane Database Syst Rev. 2013; 8:CD001691.
9. Bandstra ES, Montalvo BM, Goldberg RN, Pacheco I, Ferrer PL, Flynn J, et al. Prophylactic indomethacin for prevention of intraventricular hemorrhage in premature infants. Pediatrics. 1988; 82(4):533-42.
10. Ment LR, Oh W, Ehrenkranz RA, Philip AG, Vohr B, Allan W, et al. Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomized trial. Pediatrics. 1994; 93(4):543-50.
11. Aranda J, Thomas R. Systematic review: intravenous ibuprofen in preterm newborns. Semin Perinatol. 2006; 30(3):114-20.
12. Mittendorf R, Pryde PG. An overview of the possible relationship between antenatal pharmacologic magnesium and cerebral palsy. J Perinatal Med. 2000; 28(4):286-93.
13. Di Renzo GC, Mignosa M, Gerli S, Burnelli L, Luzi G, Clerici G, et al. The combined maternal 

administration of magnesium sulfate and aminophylline reduces intraventricular hemorrhage in very preterm neonates. Am J Obstet Gynecol. 2005; 192(2):433-8.
14. Garnier Y, Middelanis J, Jensen A, Berger R. Neuroprotective effects of magnesium on metabolic disturbance in fetal hippocampal slices after oxygen-glucose deprivation: mediation by nitric oxide system. J Soc Gynecol Investig. 2002; 9(2):86-92.
15. Elimian A, Verma R, Ogburn P, Wiencek V, Spitzer A, Quirk J. Magnesium sulfate and neonatal outcomes of preterm neonates. J Matern Fetal Neonatal Med. 2002; 12(2):118-22.
16. Petrova A, Mehta R. Magnesium sulfate tocolysis and intraventricular hemorrhage in very preterm infants. Indian J Pediatr. 2012; 79(1):43-7.
17. Parashi S, Bordbar A, Mahmoodi Y, Jafari MR. The survey of magnesium sulfate in prevention of intraventricular hemorrhage in premature infants: a randomized clinical trial. Shiraz E Med J. 2017; 18(11):e55094.
18. The American college of Obstetricians and gynecologist. Committee opinion No 652: magnesium sulfate use in obstetrics. Obstet Gynecol. 2016; 127(1):e52-3.
19. Kent AL,Wright IM, Abdel-Latif ME. Mortality and adverse neurologic outcomes are greater in preterm male infants. Pediatrics. 2012; 129(1):124-31.
20. Mohammed MA, Aly H. Male gender is associated with intraventricular hemorrhage. Pediatrics. 2010; 125(2):e333-9.