News-Medical.net also reports on the trial confirming the neuro protective effect of magnesium sulfate I earlier discussed in “If Mother 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 N-M.net 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.
In an opinion piece published in the June issue of the American Journal of Obstetrics and Gynecology, Dr. Dwight J. Rouse from the Center of Women’s Reproductive Health at the University of Alabama at Birmingham, suggests that a thousand fewer children each year would suffer from handicapping cerebral palsy if magnesium sulfate were uniformly administered to mothers prior to delivery of children born prematurely at 32 weeks gestation or sooner.
Indeed, a debate has been ongoing about the use of magnesium sulfate to lower the risk of cerebral palsy for many years. Between 2003 and 2008 three large studies of magnesium sulfate used to protect the infant brain were reported. Individually and collectively the results of the studies justify the administration of magnesium sulfate to pregnant women threatening delivery prior to 32 weeks to protect their babies who survive their preterm birth from developing cerebral palsy.
In spite of the published studies and the opinion piece by Dr. Rouse and others, magnesium sulfate remains, “unproven” and its use is not the standard of practice for preventing cerebral palsy though it is regularly used by obstetricians for the treatment of other conditions.
Where are the voices of mothers and mothers to be in this debate. For those who know the hardships faced by children with cerebral palsy and their families, the lack of action by leaders in obstetrics to bring about a change is inexplicable but not uncommon.
Many children died needlessly from neonatal respiratory distress syndrome during the 22 year period between the first individual trial which demonstrated in 1972 that steroids given to the mother prior to birth would be effective in preventing the syndrome until 1994 when the National Institutes of Health consensus guidelines were published making the administration of steroids prior to early preterm birth standard.