School-Age Outcomes following a Randomized Controlled Trial of Magnesium Sulfate for Neuroprotection of Preterm Infants

From the Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital; Region INSERM Team 28 “NeoVasc”, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute for Biomedical Research, Rouen University; and Departments of Anesthetics and Intensive Care, Biostatistics, and T he development of strategies for fetal neuroprotection is a key issue in modern perinatal medicine. To date, 5 randomized controlled trials, including the French PREMAG trial, have demonstrated a neuroprotective effect of prenatal exposure to MgSO4. 1-6 A meta-analysis of these 5 trials found that prenatal MgSO4 treatment significantly reduced the risk of cerebral palsy (CP) at age 2 years. The mechanism of the protection conferred by MgSO4 remains unclear. Theoretically, MgSO4 has multiple beneficial effects related to its reduction in neural and endothelial cell dysfunction, but it has potentially deleterious effects as well. Therefore, we followed up the French PREMAG cohort to evaluate the children for any long-term deleterious effects of MgSO4, and to assess developmental and psychomotor outcomes at school-age.