Antenatal magnesium sulfate prior to very preterm birth in routine care is associated with increased survival without cerebral palsy

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• Picked for Family Practice (top studies of the week, 2 August 2026).
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Abstract

BACKGROUND: In the last 2 decades, based on systematic reviews of randomized controlled trials, antenatal magnesium sulfate has been variably implemented internationally for fetal neuroprotection. OBJECTIVE: Our objective was to assess the effects of magnesium sulfate exposure prior to extremely preterm/low birthweight birth on survival without cerebral palsy or moderate-severe functional impairment in an Australian and New Zealand cohort. STUDY DESIGN: This population-based retrospective cohort study, using data from the Australian and New Zealand Neonatal Network registry, included neonates born from 1/1/2012 through 12/31/2020 at < 30 weeks' gestation; due to data availability, 2-3 year follow up was restricted to those born through 12/31/2017 at < 28 weeks' gestation and/or weighing < 1000 g. Analyses were performed using logistic regression with adjustment for potential confounding. RESULTS: The cohort included 16582 neonates for outcomes to hospital discharge. For primary outcomes at 2-3 years, among 6763 infants (4353 [64%] exposed to magnesium sulfate), exposure to magnesium sulfate was associated with a reduced risk of death or cerebral palsy (adjusted relative risk 0.83, 95% confidence interval 0.74-0.93) and of death or moderate-severe functional impairment (adjusted relative risk 0.88, 95% confidence interval 0.81-0.97). A clear reduction in cerebral palsy was observed for children born from singleton pregnancies (adjusted relative risk 0.68, 95% confidence interval 0.47-0.98). When multiples were included, the reduced risk of cerebral palsy was not statistically significant (adjusted relative risk 0.78, 95% confidence interval 0.59-1.05). CONCLUSIONS: Our large, binational study demonstrates real-world benefits of exposure to magnesium sulfate prior to extremely preterm and/or low birthweight birth, including increased survival without cerebral palsy or moderate-severe functional impairment, strongly supporting ongoing and enhanced implementation.

Abstract as published, via PubMed.