Aug. 27, 2008 -- Premature babies face a number of health risks -- from anemia to brain damage.
But now doctors are turning a hopeful eye toward a common compound known as Epsom salt as a possible way to cut the risk of one of the many disorders for which preemies are at heightened risk -- cerebral palsy.
Cerebral palsy, or CP for short, is a disorder that affects movement, motor skills and muscle coordination because of brain damage caused during birth. There is currently no cure for the disorder, and treatment options have been shown to offer very limited success for cerebral palsy patients.
But a study released today in the New England Journal of Medicine finds that giving moms an infusion of magnesium sulfate -- better known as Epsom salt -- just before they go into premature labor might cut their child's risk for developing cerebral palsy by about a half.
The study looked at more than 2,200 pregnant women who were at high risk for premature birth. Half of the women were randomly assigned to receive an infusion of Epsom salt if they went into early labor, while the other half received a placebo infusion.
Researchers found that moderate or severe cerebral palsy occurred only half as often in the babies whose mothers received Epsom salt compared to those babies who were in the placebo group.
Moreover, researchers found that the rates of death between the two groups did not differ, suggesting that such infusions are a safe treatment option.
If correct, the finding could have major implications. The United Cerebral Palsy Foundation estimates that nearly 800,000 children and adults in the United States are living with one or more of the symptoms of cerebral palsy. According to the Centers for Disease Control and Prevention, about 10,000 babies are born with cerebral palsy in the United States each year.
Lead study investigator Dr. Dwight Rouse, professor and director of the Center for Women's Reproductive Health at the University of Alabama at Birmingham, said this practice should be strongly considered for women at risk of delivering before 32 weeks.
"I think we have enough data that this should be a strategy considered when women threaten to deliver very early," Rouse said. "If we look at women at less than 28 weeks, we would need to treat only 30 women to prevent one case of moderate to severe cerebral palsy."
Not All Doctors Convinced
However, many neonatal experts urged caution when viewing these results, saying that more study is needed before this treatment should be considered as a standard of care.
"My personal feeling is that this study is important as further confirmation of safety but does not provide sufficiently compelling data to permit recommendation of magnesium sulfate as a standard of care," said Dr. Sessions Cole, director of the division of pediatric newborn medicine at Washington University in St. Louis. "I would hate to have the conclusion be that somehow we now know the way to prevent cerebral palsy, because we don't."
Still, the concept of using magnesium sulfate as a tool to protect the brains of premature babies is not a new one. Past studies have also looked into whether magnesium sulfate might ward off cerebral palsy by stabilizing blood vessels and maintaining oxygen flow to the baby. In fact, a study presented at the Society for Maternal-Fetal Medicine annual meeting in Dallas in January also found that the use of magnesium sulfate cut premature babies' risk for cerebral palsy by about a half.
The use of magnesium sulfate as a possible treatment for cerebral palsy is an appealing idea to many doctors: The compound is already used regularly to halt contractions when women go into labor very early. Moreover, the drug is found in virtually every hospital's delivery room and costs only pennies for one dose.
Based on this research, Dr. Sandra McCalla, director of the Division of Obstetrics at Maimonides Medical Center in Brooklyn, N.Y., told John McKenzie of "World News With Charles Gibson" that she believes "this is one of the most promising breakthroughs in decades to help pregnant women at imminent [risk] for premature delivery."
But despite past success with this treatment in previous studies, many experts remain hopeful but cautious about which patients might benefit from this treatment.
"The results call for more study as to mechanism, potential toxicities and identification of specific preterm infants for whom this approach may be beneficial," said Dr. H. William Taeusch, professor of pediatrics at the University of California at San Francisco. "There is no direct evidence of the mechanism of the effect. Nor are potential side effects of [magnesium sulfate] in the newborn fully explored in this study."
More Study Needed
Many experts also warned that although this study touts magnesium sulfate as a safe treatment for both mother and baby, the side effects of the treatment have not been studied extensively enough to make such a conclusion.
"To say that this is a safe practice is a bit of an overstatement," said Dr. Steven Donn, professor of pediatrics and director of the Division of Neonatal-Perinatal Medicine at the University of Michigan Health System. "High serum magnesium levels in the newborn also depress respiratory drive, sometimes requiring the use of mechanical ventilation where it might not have been needed, and it can interfere with gastrointestinal function and delay feeding."
Moreover, many experts agreed that the number of patients needed to be treated with magnesium sulfate in order to prevent one case of CP is much too high for this to be considered as a new standard of care for women at risk for premature birth.
"Remember, this study was conducted in very subspecialized centers, with abundant skilled providers for both mothers and babies," Donn said. "What happens when it is moved to community hospitals may have a totally different result."
"What is likely to happen is that it will be used more liberally and pragmatically, increasing the denominator of patients and probably diluting the effect," he said.
Overall, experts agree that the prudent way to view these findings is with cautious hope.
"Neonatology has had enough misadventures with drugs that initially 'looked good,' only to find out later that there were significant side effects and complications, sometimes life-threatening, that we need to await longer term outcomes before embracing a new therapy as a standard practice," Donn added.