Timing of administration of antenatal magnesium sulphate and correlation with umbilical cord blood magnesium levels in preterm babies.

[Display omitted] • Preterm brain damage is still a significant and unresolved problem for neonatologists. • Knowledge of the predictors of the cord blood magnesium levels help elucidate the ideal MgSO4 regimen and timing of administration. • Efficacy of MgSO4 for fetal Neuroprotection is accepted, Optimum timing of administration in relation to delivery and Optimal dosing regimen remains unknown. • We have compared the neonatal outcomes of different duration groups in different gestations with Cord blood magnesium as a tool. • We found that the mean cord blood magnesium level was found to be 3.8 mg/dl to serve the purpose of neuroprotection. To achieve this target, the standard dosing regimen of 4gm Bolus followed by Infusion should be administered for at-least 6 h prior to delivery. The effectiveness of MgSO4 for foetal neuroprotection is acknowledged, but the best time to provide it in relation to birth is a conundrum, and dose schedule is yet unknown. Understanding the determinants of the magnesium levels in cord blood aids in determining the appropriate timing and length of administration. To assess the cord blood magnesium concentration in relation to the timing of MgSO4 and delivery. To achieve ROC in relation to optimum level of cord blood magnesium concentration in relation to neonatal outcome variables. A prospective observational study conducted in a tertiary care hospital over 2 years in women having preterm delivery from 26 weeks to 33 + 6 weeks, who received Neuroprophylaxis. Cord blood was collected for magnesium level estimation. Baby followed 24 h after delivery. ROC analysis performed for predicting an optimal cut-off for a continuous predictor predicting binary outcome. 85 recruited cases divided into bolus group, bolus + infusion group. The mean cord blood magnesium (n = 85) was 3.8 mg/dl. The AUROC for Gestational Age at Administration predicting Baby Outcome: 0.699, It was statistically significant (p = 0.034). The AUROC for Cord Blood Mg predicting Baby Outcome: 0.606, It was not statistically significant (p = 0.262). Mean cord blood magnesium levels served as a tool to determine the timing and duration of Neuroprophylaxis. Mean cord blood magnesium of 3.8 mg/dl should be achieved to serve the purpose of Neuroprotection. To achieve this, Bolus followed by Infusion should be administered for at-least 6 h prior to delivery. [ABSTRACT FROM AUTHOR]