PMID- 35165613
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220216
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 1
DP  - 2022 Jan
TI  - Efficacy of Magnesium Sulfate in Addition to Melatonin Therapy in Neonates With 
      Hypoxic-Ischemic Encephalopathy.
PG  - e21163
LID - 10.7759/cureus.21163 [doi]
LID - e21163
AB  - BACKGROUND: One of the most important causes of neonatal deaths in developing 
      nations is birth asphyxia. Though the probability of a complete recovery is very 
      low, hypoxic-ischemic encephalopathy (HIE) associated with asphyxia can be 
      managed with multiple treatment options. The study evaluated the efficacy of the 
      addition of magnesium sulfate (MgSO(4)) to melatonin therapy in neonates with 
      HIE. METHODOLOGY: A prospective, observational study was conducted in the 
      department of neonatal intensive care, Pakistan Institute of Medical Sciences 
      Hospital, Islamabad, Pakistan from October 2020 to March 2021. All neonates with 
      an Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score of less 
      than five at five minutes, umbilical blood pH of less than 7.0, and moderate 
      neonatal encephalopathy as detected on the modified Sarnat score which is a 
      clinical tool used for the assessment of the severity of HIE were included in the 
      study. Neonates with congenital abnormalities, intrauterine growth retardation, 
      neonatal sepsis, and infants born to mothers with diabetes mellitus type 2 were 
      excluded from the study. The infants were randomly assigned to either of the 
      groups, i.e., i) group 1 included neonates who were administered at least three 
      doses of magnesium sulfate (MgSO(4)) infusion in addition to melatonin, or ii) 
      group 2 included neonates who were administered melatonin only. Blood samples of 
      all neonates were evaluated and compared between the two groups. RESULTS: A total 
      of 90 neonates with HIE were included in the study. There was a predominance of 
      female neonates. The mean ages of babies in group 1 and group 2 were 37.2 +/- 0.43 
      and 37.3 +/- 0.59 weeks, respectively. The mean weight on the term was 2.88 +/- 0.11 
      and 2.89 +/- 0.10, respectively. The Apgar score at 5 mins in group 1 was 1.73 +/- 
      0.81 while in group 2, 1.82 +/- 0.94. It was found that there was a more 
      significant improvement in pH after 3 days and after one week of treatment in 
      group 1 as compared to group 2. The mean pH in babies after three days of 
      intervention was 7.23 +/- 0.03 in group 1 which was significantly better than group 
      2 (p<0.0001). After seven days, the mean normalized to 7.39 +/- 0.04 in group 1 (p 
      < 0.0001). It was found that in patients in group 1, the mortality was lower than 
      in group 2 (p < 0.0001). CONCLUSION: HIE patients who were administered melatonin 
      in combination with magnesium sulfate yielded better patient outcomes. Thus, it 
      was concluded that the use of magnesium sulfate as dual therapy with melatonin 
      improved patient outcomes for HIE. However, it is recommended that similar 
      studies are conducted with a wider range of parameters, such as duration of 
      hospital stay and assessment of the neurological outcomes of the patients.
CI  - Copyright (c) 2022, Khan et al.
FAU - Khan, Muhammad H
AU  - Khan MH
AD  - Department of Neonatology, Pakistan Institute of Medical Sciences, Islamabad, 
      PAK.
FAU - Ann, Qurrat-Ul
AU  - Ann QU
AD  - Department of Neonatology, Pakistan Institute of Medical Sciences, Islamabad, 
      PAK.
FAU - Khan, Muhammad S
AU  - Khan MS
AD  - Department of Neonatology, Pakistan Atomic Energy Commission General Hospital, 
      Islamabad, PAK.
FAU - Ahmad, Nadeem
AU  - Ahmad N
AD  - Department of Neonatology, Pakistan Institute of Medical Sciences, Islamabad, 
      PAK.
FAU - Ahmed, Moiz
AU  - Ahmed M
AD  - Department of Neonatology, Jinnah Postgraduate Medical Centre, Karachi, PAK.
LA  - eng
PT  - Journal Article
DEP - 20220112
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8833294
OTO - NOTNLM
OT  - hie
OT  - hypoxic-ischemic encephalopathy
OT  - magnesium sulfate
OT  - melatonin
OT  - mgso4
OT  - neonates
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/02/16 06:00
MHDA- 2022/02/16 06:01
PMCR- 2022/01/12
CRDT- 2022/02/15 05:37
PHST- 2022/01/10 00:00 [accepted]
PHST- 2022/02/15 05:37 [entrez]
PHST- 2022/02/16 06:00 [pubmed]
PHST- 2022/02/16 06:01 [medline]
PHST- 2022/01/12 00:00 [pmc-release]
AID - 10.7759/cureus.21163 [doi]
PST - epublish
SO  - Cureus. 2022 Jan 12;14(1):e21163. doi: 10.7759/cureus.21163. eCollection 2022 
      Jan.