Sulfato de magnesio antenatal y eliminación tardía de meconio: Estudio multicéntrico / Antenatal magnesium sulphate and delayed passage of meconium: A multicentre study

Introducción: La relación entre sulfato de magnesio (MgSO4) y el retraso en la evacuación de meconio presenta resultados controvertidos en la literatura. Objetivos: Determinar si existe relación entre la administración de MgSO4 a la madre y la eliminación tardía de meconio (ETM) en el neonato y conocer los niveles de magnesio en sangre en estos, con respecto a la dosis acumulada de MgSO4 administrada a la madre. Población y métodos: Estudio descriptivo-analítico, en pacientes ≤ 32 semanas de edad gestacional, con diseño retrospectivo-prospectivo, llevado a cabo en dos hospitales de tercer nivel asistencial. Se definió la ETM como retraso en la evacuación meconial ≥ 48 horas y/o necesidad de estimulación rectal en ≥ 2 ocasiones para realizar deposición y/o retraso ≥ 48 horas entre la primera y segunda deposición. Resultados: Se reclutaron 283 pacientes (204 retrospectiva y 79 prospectivamente), de los cuales 152 (53,7%) presentó ETM. No se encontró relación entre la administración de MgSO4 a la madre, ni la dosis acumulada de MgSO4 en esta, ni los niveles de magnesio en sangre del neonato con la presencia de ETM. La mayor edad gestacional (OR 0,8, IC 0,69-0,93, p = 0,003) resultó factor protector independiente de la ETM y la necesidad de reanimación avanzada (OR 2,24, IC 1,04-4,86, p = 0,04) factor de riesgo. Conclusiones: Los niveles alcanzados de magnesio en sangre del neonato con las dosis de MgSO4 administradas a las madres, no se relacionan con la ETM. La menor edad gestacional y la necesidad de reanimación avanzada predicen mayor riesgo de ETM. (AU)

Introduction: The published evidence on the association between magnesium sulphate (MgSO4) and delayed passage of meconium (DPM) is contradictory. Objectives: To determine whether there is an association between the administration of MgSO4 to the mother and DPM in the neonate, and to analyse serum magnesium levels in neonates in relation to the cumulative dose of MgSO4 administered to the mother. Population and methods: Retrospective and prospective descriptive and analytical study conducted in patients delivered at or before 32 weeks of gestation in 2 tertiary care hospitals. Delayed passage of meconium was defined as failure to pass meconium within 48 hours of birth and/or need for rectal stimulation on 2 or more occasions to pass stool and/or interval of at least 48 hours between the first and second bowel movements. Results: The study included 283 patients (204 retrospectively and 79 prospectively), of who 152 (53.7%) experienced DPM. Delayed passage of meconium was not associated with antenatal MgSO4 administration, the cumulative maternal MgSO4 dose or neonatal serum magnesium levels. Older gestational age (OR, 0.8; confidence interval [CI], 0.69–0.93; P = .003) was an independent protective factor against DPM, while the need for advanced resuscitation (OR, 2.24; CI 1.04–4.86; P = .04) was a risk factor for DPM. Conclusion: The neonatal serum levels of magnesium reached with the doses of MgSO4 administered to mothers were not associated with DPM. Lower gestational age and the need for advanced resuscitation were predictors associated with an increased risk of DPM. (AU)

Antenatal magnesium sulphate and delayed passage of meconium: A multicentre study.

INTRODUCTION: The published evidence on the association between magnesium sulphate (MgSO4) and delayed passage of meconium (DPM) is contradictory. OBJECTIVES: To determine whether there is an association between the administration of MgSO4 to the mother and DPM in the neonate, and to analyse serum magnesium levels in neonates in relation to the cumulative dose of MgSO4 administered to the mother. POPULATION AND METHODS: Retrospective and prospective descriptive and analytical study conducted in patients delivered at or before 32 weeks of gestation in 2 tertiary care hospitals. Delayed passage of meconium was defined as failure to pass meconium within 48 h of birth and/or need for rectal stimulation on 2 or more occasions to pass stool and/or interval of at least 48 h between the first and second bowel movements. RESULTS: The study included 283 patients (204 retrospectively and 79 prospectively), of who 152 (53.7%) experienced DPM. Delayed passage of meconium was not associated with antenatal MgSO4 administration, the cumulative maternal MgSO4 dose or neonatal serum magnesium levels. Older gestational age (OR, 0.8; confidence interval [CI], 0.69-0.93; P = 0.003) was an independent protective factor against DPM, while the need for advanced resuscitation (OR, 2.24; CI 1.04-4.86; P = 0.04) was a risk factor for DPM. CONCLUSION: The neonatal serum levels of magnesium reached with the doses of MgSO4 administered to mothers were not associated with DPM. Lower gestational age and the need for advanced resuscitation were predictors associated with an increased risk of DPM.

Fatal Staphylococcus Aureus Endocarditis Misdiagnosed as Multisystem Inflammatory Syndrome in Children.

We present a case of a 10-year-old male with Staphylococcus aureus mitral endocarditis who was initially misdiagnosed with multisystem inflammatory syndrome associated with coronavirus disease 2019, with eventual fatal outcome due to brain hemorrhage after cardiac intervention. Our case differs from recent studies, in which microbleeds did not increase the risk of hemorrhagic stroke or global mortality risk.