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Preterm infants born to mothers receiving Intravenous magnesium sulfate - a common treatment to delay labor - are less likely to develop Cerebral Palsy than are preterm infants whose mothers do not receive it, report researchers in a large National Institutes of Health research network.

The study results appear in the August 28, 2008 New England Journal of Medicine.

"A third of all cases of Cerebral Palsy are associated with preterm birth," said NIH Director Elias A. Zerhouni, M.D. "This study shows a significant reduction in cerebral palsy among preterm infants whose mothers were given magnesium sulfate."

The researchers theorized that magnesium sulfate protects against cerebral palsy because it can stabilize Blood vessels, protect against damage from oxygen depletion, and protects against injury from swelling and Inflammation.

Cerebral palsy refers to a group of neurological disorders affecting control of movement and posture and which limit activity. The brain may be injured or develop abnormally during pregnancy, birth or in early childhood. The causes of cerebral palsy are not well understood.

The research was conducted by investigators in 20 participating research centers of the Maternal Fetal Medicine Units Network of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The study’s first author was Dwight J. Rouse, M.D., of the University of Alabama at Birmingham. Major funding was provided by NIH’s National Institute of Neurological Disorders and Stroke (NINDS).

A 1995 study by NINDS researcher Karin Nelson, M.D., and a researcher at the California Department of Health Services found that mothers of preterm infants who did not have cerebral palsy were more likely to have received magnesium sulfate than were mothers of infants who had cerebral palsy. Two larger randomized studies that subsequently were undertaken suggested that magnesium sulfate given to pregnant women delivering prematurely might protect their infants against cerebral palsy, but their results were inconclusive.

"Our study is the largest, most comprehensive effort to date that looked at using this inexpensive and commonly used treatment to reduce the occurrence of cerebral palsy after preterm birth," said Deborah Hirtz, M.D., a Pediatric neurologist at NINDS, and an author of the study. "Cerebral palsy can’t always be prevented, but the data from our study and its predecessors will help obstetricians make informed treatment decisions for the women under their care."

Women at the 20 participating NICHD Maternal Fetal Medicine Unit Network sites were eligible to participate. The women were from 24 to 31 weeks pregnant and at risk for preterm delivery. When the women went into labor, they were assigned at random to receive intravenously a solution of either magnesium sulfate or a Placebo. The women in the treatment group were given 6 grams of magnesium sulfate intravenously over 20 to 30 minutes, followed by 2 grams of magnesium sulfate every hour after that until either 12 hours had passed, labor had subsided, or they had given birth. If the women in either group did not deliver within 12 hours, they were treated again if they went into labor by the 34th week of pregnancy.

For purposes of their statistical analysis, the researchers calculated the rates of moderate cerebral palsy, severe cerebral palsy, and death among the infants in the study. The study authors did not include mild cerebral palsy in this calculation, as mild cerebral palsy will often disappear with time.

When the researchers considered only moderate and severe cerebral palsy together, cerebral palsy occurred less frequently in the magnesium sulfate group (1.9 percent) as compared to the placebo group (3.5 percent).

For their primary calculation, the researchers grouped the proportions of infants with moderate and severe cerebral palsy together with the proportion of infants who died. The researchers included the death rate in this primary calculation, because mortality among preterm infants is very high. The researchers found that a total of 11.3 percent of infants in the magnesium sulfate group had either moderate or severe cerebral palsy, or had died at birth or were stillborn. In contrast, a total of 11.7 percent of the infants in the placebo group had moderate to severe cerebral palsy or had died.

The proportion of deaths occurring in the magnesium sulfate group (9.5 percent) did not differ significantly from those in the placebo group (8.5 percent).

There was no difference in the average gestational age between the two groups of infants.

Cerebral palsy was diagnosed in 41 children from 942 magnesium sulfate-treated pregnancies, as compared to 74 children from 1,002 placebo-treated pregnancies. Of the children in the magnesium sulfate group, 2.2 percent had cerebral palsy classified as mild, 1.5 percent as moderate, and 0.5 percent as severe. A higher proportion of children in the placebo group than in the magnesium sulfate group had cerebral palsy. Of the children in the placebo group, 3.7 percent had mild cases of cerebral palsy, 2.0 percent had moderate cases, and 1.6 percent had severe cases.

"This is a major advance," said Catherine Y. Spong, M.D., Chief of NICHD’s Pregnancy and Perinatology Branch and an author of the study. "Our results show that obstetricians can use magnesium sulfate, which they have experience prescribing, to reduce the risk of a devastating condition, cerebral palsy, in preterm infants."

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Among workers at small, private sector-companies, only about half (48 percent) who had single-person health insurance in 2005 were required to contribute to monthly premiums, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). By comparison, 86 percent of workers at large companies (with 50 or more on the payroll) with health insurance were required to pay for individual coverage.

The contrast was also seen among workers with family coverage. At small firms, 64 percent of them contributed to premiums. At larger firms, 91 percent contributed.

AHRQ’s new analysis also showed the portion of workers who contributed to premiums varied by geography in the 10 most populous states:

For small companies:

• California had one of the highest portions of workers who didn’t contribute to premiums for single-person coverage: 63 percent. Ohio had one of the lowest at 37 percent.
• New York had one of the highest portions of workers who had family coverage but didn’t contribute to premiums: 55 percent. Texas had one of the lowest at 29 percent.

For large companies:

• California had the highest portion of workers who had individual coverage but didn’t contribute to premiums at 27 percent. At 10 percent, Florida had one of the lowest.
• California also had one of the highest portions of employees with family coverage who didn’t contribute to premiums: 16 percent. Georgia had one of the lowest: 1 percent.

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Hospitalizations of children principally for Asthma fell by almost 60,000 between 1997 and 2006, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). However, the number of children who are admitted to hospitals to treat other conditions but also have asthma rose by nearly 70,000 during the same period.

In 2006, there were 335,000 hospital stays for children with asthma. In 137,000 cases, the children were admitted specifically to treat asthma. In the remaining 197,000 cases the children had asthma but were being treated for another illness which are often directly related to asthma (for instance, Pneumonia or bronchitis).

AHRQ also found that:

• Children from poorer communities, where the average income was less than $37,000 a year, were 76 percent more likely to be admitted than those from wealthier communities, where the average income was greater than $37,000 a year (2.7 admissions per 1,000 children versus 1.5 admissions per 1,000 children, respectively).
• Poor children with asthma as a coexisting illness were 54 percent more likely to be hospitalized than children from wealthier communities (3.5 admissions per 1,000 children versus 2.3 admissions per 1,000 children, respectively).
• Infants under 1 year of age were 4 times more likely to be hospitalized for asthma than children ages 15 to 17 (5.1 admissions per 1,000 children compared with 1.8 admissions per 1,000 children).
• Roughly 27 percent of all children admitted for pneumonia also had asthma, as did 9 percent of those hospitalized for acute bronchitis; and 5 percent for Depression or bipolar disease.

Asthma is the most common chronic disorder in children. Attacks, usually characterized by shortness of breath, wheezing, coughing, chest Pain, Anxiety, or Panic, can be triggered by a wide range of causes including cigarette smoke, animal hair, colds, and allergies. Asthma is usually managed by office doctors but when the disease gets out of control, hospitalization is necessary.

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About 6,200 Americans are hospitalized each summer due to excessive heat, and those at highest risk are poor, uninsured, or elderly, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). About 180 people who were hospitalized for heat exposure died in 2005, according to the AHRQ analysis.

Severe heat exposure, called hyperthermia, occurs when body temperatures rise to 106 degrees Fahrenheit or more. Heat exhaustion symptoms range from nausea and vomiting to weakness, headache and muscle cramps. More extreme heat Stroke may cause a rapid pulse, difficulty breathing, mental confusion, seizure and Coma.

AHRQ's analysis, based on 2005 data, found that:

• People from communities with average household incomes of $36,999 or less were hospitalized more than twice as often as people who came from wealthier areas where average household incomes topped $61,000.
• The rate of hyperthermia hospital admissions for uninsured patients was significantly higher (17 percent) than hospital admissions for uninsured patients as a whole (5 percent).
• The hospitalization rate for people over 65 with hyperthermia was 15 times greater than for people age 17 and younger.
• The rate of admission for hyperthermia in the South (3.1 per 100,000 population) was more than twice that of the Midwest and West (1.4 per 100,000 each). The Northeast had a rate of 1.7 per 100,000 for hyperthermia.