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Background/Objectives: Magnesium sulfate (MgSO4) has historically been used in obstetrics as a tocolytic and to prevent eclamptic seizures. MgSO4 has also been investigated as a potential neonatal neuroprotectant for infants born preterm. However, randomized controlled trials of prenatal MgSO4 have shown mixed results, with single-center observational studies also suggesting differential effects by sex. We sought to evaluate sex-dependent associations between prenatal MgSO4 exposure and standardized neurodevelopmental outcomes in a large, multi-center cohort of extremely preterm neonates (24–0/7 to 27–6/7 weeks’ gestation) from the Preterm Erythropoietin Neuroprotection Trial (PENUT). Methods: The relationship between maternal MgSO4 exposure and neurodevelopmental outcomes assessed at 2 years using the Bayley Scales of Infant and Toddler Development Index, 3rd edition was examined by sex in n = 666 infants (n = 328 female, n = 338 male). To account for confounding by indication, we performed both matching and inverse probability weighting using 17 maternal predictors of MgSO4 exposure. Results: In both unadjusted and adjusted (weighted and matched) analyses, no relationship between MgSO4 exposure and neurodevelopmental outcomes was seen, either overall or by sex. Conclusions: This study reaffirms the safety of MgSO4, but appropriate clinical trials of MgSO4 in extremely preterm infants are still required to better understand any effects on neurodevelopmental outcomes.
DiNucci et al. (Thu,) studied this question.