Effect of Intravenous Magnesium Sulphate on in-Hospital Mortality in Neonates with Perinatal Asphyxia: A Prospective Cohort Study

Background: Early neonatal deaths in Pakistan account for 7% of global neonatal mortality rate, with perinatal asphyxia being responsible for 23% of these cases. Controversy exists in the literature regarding role of magnesium sulphate administration on reducing in-hospital mortality in newborns with perinatal asphyxia.Objectives: To determine the effect of intravenous magnesium sulphate on in-hospital mortality in neonates with perinatal asphyxia.Methods: This prospective cohort study was conducted at the Department of Pediatric Medicine, Nishtar Hospital Multan over a period of six months from January 2022 to June 2022. A total of 183 consecutive full -term neonates, weighing = 2500 grams, with Apgar score < 7 at 5-minutes after birth, presenting within 48 -hours of life were included in the study. Neonates presenting within 6-hours after birth received intravenous magnesium sulphate (MgSO4) - exposed group and neonates presenting after 6-hours did not get MgSO(4 )unexposed group. Baseline characteristics and survival outcome was recorded. Binary logistic regression analysis was run and Kaplan-Meier survival curve is constructed for the assessment of mortality.Results: There were 90 neonates in exposed group and 93 in unexposed group. Males constituted 53% of the study population. Overall mortality rate was 15.8% (n=29). Severe asphyxia (RR 8.5, 95% CI 4.0 - 18.0; p < 0.001) and spontaneous vaginal delivery (RR 1.8, 95% CI 1.1 - 2.9; p = 0.02) were the independent predictors of mortality. Mortality (7.8% vs. 23.6%, p-value 0.003) was significantly higher in unexposed group compared to exposed group. In exposed group the median survival time was 16 days (95% CI-8.7 - 23.3) compared to 11 days (95% CI 9.9 - 12.0) in unexposed group (Log-rank test: ?(2) = 6.03, df-1, p = 0.01). Conclusion: Magnesium sulphate was effective in lowering neonatal mortality due to moderate-severe perinatal asphyxia. In order to further validate its impact on mortality, multi-center studies are suggested.