| Perinatal asphyxia
A systematic review [5] of RCTs that compared magnesium to control in newborns with HIE included 5 studies.[6-10] All used magnesium sulfate given within 24 hours of birth. The dose varied: 250mg/kg every 24 hours for three doses in two studies, 250mg/kg followed by two doses of 125mg/kg every 24 hours for two doses in another two studies and a single dose of 250mg/kg in one study. Magnesium was administered over 30 min in one study, over 1 hour in three studies. There was no difference in the death or moderate-to-severe neurodevelopmental disability at 18 months between the magnesium and the control groups (RR 0.81, 95% CI 0.36 to 1.84). There was significant reduction in the unfavourable short-term composite outcome (survival with abnormalities in any of the following: neurodevelopmental exam, neuroimaging or neurophysiologic studies), (RR 0.48, 95% CI 0.30 to 0.77) but no difference in mortality (RR 1.39, 95% CI 0.85 to 2.27), seizures (RR 0.84, 95% CI 0.59 to 1.19) or hypotension (RR 1.28, 95% CI 0.69 to 2.38) between the magnesium and the control groups. Conclusion: There is insufficient evidence to determine if magnesium therapy given shortly after birth to newborns with HIE reduces death or moderate-to-severe disability. The improvement in short-term outcomes without significant increase in adverse effects supports the need for further adequately powered trials to determine if there are long-term benefits of magnesium and to confirm its safety. (LOE I GOR D) The publication of 3 additional small trials is unlikely to change this conclusion. [11-14]
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