Antenatal magnesium sulfate and spontaneous intestinal perforation in infants less than 25 weeks gestation

Objective:evaluate spontaneous intestinal perforation (sip)/death among extremely low birthweight (elbw) infants before, during and after initiation of an antenatal magnesium for neuroprotection protocol (mgpro).study design:we tested associations between sip/death and magnesium exposure, gestational age (ga) and interactions with ga and magnesium exposure in a cohort of inborn elbw infants before, during and after mgpro.result:one hundred and fifty-five elbw infants were included, 81 before, 23 during and 51 after mgpro. elbw infants (78.3%) were exposed to mg during mgpro compared with 50.6% and 60.8% before and after, respectively. incidence of sip on protocol was 30.4% vs 12.9% off protocol (p=0.03). ga was strongly associated with sip (p<0.01). antenatal mg dose was also associated with sip/death regardless of epoch (odds ratio 9.3 (1.04–104.6)), but increased sip/death was limited to those <25 weeks gestation.conclusion:higher mg dose was associated with higher sip and death risk among infants with the lowest birthweights. validation of this observation in larger populations is warranted.