Magnesium for Neuroprotection

  1. 0
    So, recently I cared for a patient just over 31 weeks gestation with a hx of PTL admitted for PPROM. She was given our standard PPROM antibiotic protocol, steroids for baby's lungs, and magnesium sulfate for 24 hours for neuroprotection for the baby. I cared for her when she started going into labor, just a day or two after her initial magnesium infusion had been completed. Once her cervix started dilating and she was indeed in active labor, the OB ordered magnesium to be started again. I'm a little confused as to why we had to Mag this patient more than once. While some nurses on my unit confirmed that this was standard protocol, others were just as surprised as I was.

    What is the magnesium policy on your units? If you have a patient in early enough preterm labor, do you mag her during labor (strictly for neuroprotection for baby, when hypertension is NOT an issue), regardless of whether she has already completed a previous magnesium infusion?
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  5. 0
    Yes mag for neuroprotection. In talking with the residents, we do Mag 4gm load and then 2gm per hour for neuroprotection. We usually ship off our early ones if under 1500gm, so we start the load then do the 2gm/hr....I don't think I've recently had a Mag pt who needed a second dosing of Mag for preterm, so I'm not sure but I don't find it too unusual.
  6. 0
    Mag is only good for neuroprotection if it is "onboard", so to speak, at the time of delivery (administration 2-24hrs prior to delivery is recommended by ACOG, I think). So, for instance, a mom at risk of imminent delivery receives Magnesium Sulfate for neuroprotection. Her labor is then adequately stalled and Mag is discontinued. When labor starts again, if she still meets criteria for Mag for neuroprotection, the Mag is then restarted. Prolonged use of Mag is not recommended, so sometimes it will be given to a mom a couple of times. Someone correct me if I've misunderstood any of this, we try to transfer all of our early moms out to a bigger hospital with a NICU prior to delivery.
  7. 0
    I don't have OB experience, but you observation about being "on board" makes nutritional/physiologic sense to me.
    Quote from nocturnalnurse
    Mag is only good for neuroprotection if it is "onboard", so to speak, at the time of delivery (administration 2-24hrs prior to delivery is recommended by ACOG, I think). So, for instance, a mom at risk of imminent delivery receives Magnesium Sulfate for neuroprotection. Her labor is then adequately stalled and Mag is discontinued. When labor starts again, if she still meets criteria for Mag for neuroprotection, the Mag is then restarted. Prolonged use of Mag is not recommended, so sometimes it will be given to a mom a couple of times. Someone correct me if I've misunderstood any of this, we try to transfer all of our early moms out to a bigger hospital with a NICU prior to delivery.
  8. 0
    Yes, at our facility, if there has been no mag on board for greater than 24 hours, and delivery is imminent, they will restart.


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