A recent Cochrane Library Editorial calls for accelerated global implementation of antenatal magnesium sulfate to protect preterm babies from developing cerebral palsy. The updated Cochrane review confirms that a simple magnesium sulfate infusion can prevent cerebral palsy in premature babies. The drug costs approximately $6.50 per dose in England and requires hospital admission with experienced staff for safe administration to the mother.
Proven Neuroprotective Benefits
The first Cochrane review, published in 2009, demonstrated magnesium sulfate's protective effects against cerebral palsy in premature babies. The recent update includes newer trials that further confirm this finding. Since 2015, the World Health Organization (WHO) has recommended it for women at risk of premature birth before 32 weeks of gestation. However, implementation remains a challenge in many areas.
Professor Karen Luyt, a neonatologist at the University of Bristol, was inspired by the original review to ensure this intervention was offered to all eligible mothers across England. This includes all women going into labor before 30 weeks of gestation, and some women between 30 and 33 weeks depending on clinical factors. According to Luyt, preterm birth is the leading cause of brain injury and cerebral palsy, with lifelong impacts on children and families. The treatment prevents cerebral palsy by around 30%.
National Rollout and Impact in England
Following the initial Cochrane review, Karen Luyt implemented the findings in her hospital through the PReCePT (prevention of cerebral palsy in pre-term labour) program. Supported by Health Innovation West of England and co-designed by parents and maternity ward staff, the program provides practical tools and training to ensure eligible mothers are offered magnesium sulfate.
Between 2018 and 2023, magnesium sulfate was given to 14,270 eligible women across England, resulting in an estimated 385 fewer cases of cerebral palsy. The widespread use of this treatment was made possible by the original Cochrane review led by Professors Lex Doyle and Caroline Crowther.
Global Implementation and Future Research
Despite the clear evidence of magnesium sulfate's cost-effectiveness and life-changing potential, not all mothers receive it. Data from the Vermont Oxford Network, which collects data from over 1,400 participating neonatal units worldwide, primarily in the USA, suggests that around two-thirds of eligible women receive magnesium sulfate. This figure is likely lower in low-resource settings.
Dr. Emily Shepherd of the South Australian Health and Medical Research Institute, lead author of the updated Cochrane review, notes that the trials combined in their review are all from high-income countries, where hospitals are comparatively well set-up to administer magnesium sulfate infusions and fulfill maternal and fetal monitoring requirements. Further research is needed to establish the minimum effective dose and alternative regimens, particularly intramuscular administration, to aid widespread implementation, including across low- and middle-income countries.
