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Reply to Dr McAdam's letter: pulmonary interstitial emphysema, antenatal magnesium sulfate and mortality in the extremely low birth weight infants

Journal of Perinatology volume 26, pages 522–523 (2006)Cite this article

We thank Dr McAdams for his letter and appreciate his comments.

We found an association between Mg10 and pulmonary interstitial emphysema (PIE) and between PIE and death in the extremely low birth weight (ELBW) infants in our study.1 However, it was not clear if death was due to these two adverse factors individually, or a combination of both. We compared infants who received Mg10 with those who did not receive Mg10 for clinical course and outcome variables. Mg10 infants had lower gestational age (GA, 25.3±1.2 vs 26.6±1.5 weeks, P=0.08); higher incidence of PIE (47 vs 18%, P=0.05); and greater incidence of death (31 vs 7%, P=0.03). Total number of days on high frequency oscillatory ventilator (HFOV, 5.2±6 vs 0.5±1.1 days, P=0.01) and the cumulative magnesium sulfate (MgSO4) dose (43±23 vs 2±3.7 g, P<0.001) were also higher in the Mg10 group. The mode of delivery, duration of rupture of the membranes, use of pressers, culture proven sepsis, days on antibiotics or incidence of placental chorioamnionitis did not differ between the two groups. In a multiple logistic regression analysis, using a model which included Mg10, PIE, GA, HFOV days and MgSO4 dose only PIE remained significantly associated with death (Odd's ratio 14.4, 95% CI 1–208, P=0.05) after controlling for all other significant predictors, suggesting that death due to Mg10 is dependent upon the development of PIE in ELBW infants. MgSO4 tocolysis has been associated with neonatal death in prior studies2 but only one study has demonstrated a dose relationship between the two variables and established an antenatal dose >48 g of MgSO4 to be associated with death.3 Our mean cumulative dose was lesser than this amount which might also explain the lack of association between Mg10 and death in the multivariate analysis.

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References

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, State University of New York School of Medicine, Stony Brook, NY, USA

    R P Verma

  2. Department of Economics, State University of New York, Stony Brook, NY, USA

    H Fang

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  1. R P Verma
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  2. H Fang
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Correspondence to R P Verma.

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Verma, R., Fang, H. Reply to Dr McAdam's letter: pulmonary interstitial emphysema, antenatal magnesium sulfate and mortality in the extremely low birth weight infants. J Perinatol 26, 522–523 (2006). https://doi.org/10.1038/sj.jp.7211553

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