Magnesium sulfate for neuroprotection: Approach to addressing clinical questions

Abstract Magnesium sulfate has been demonstrated to prevent cerebral palsy, as well as the combined outcome of cerebral palsy and death, in children who as fetuses were exposed to it in the early preterm period. This conclusion derives from clinical trials that employed heterogenous inclusion criteria (including upper and lower gestational age of eligibility, plurality, and clinical characteristics), magnesium dosing, duration of treatment, and repeat dosing strategies. Given that the demonstration of magnesium's effectiveness has not been confined to a narrow set of clinical circumstances, we can be more confident that its effectiveness is broadly generalizable. Nonetheless, the differing trial designs have left open the question about the optimal way to administer magnesium for fetal neuroprotection as well as the question for whom magnesium is indicated. Herein we will compare and contrast the clinical trials evaluating magnesium for fetal neuroprotection, and provide guidance about the rationale for our approach to common clinical questions that arise surrounding magnesium administration.