School-Age Outcomes of Very Preterm Infants and Antenatal Magnesium Sulphate Therapy - A Randomised Controlled Trial

尽管最近在出生时的护理方面取得了重大进展，导致极早产儿的存活率大幅上升，但幸存者的不良长期健康问题的比率并未减少，与非早产儿相比仍然过高。特别是，他们的大脑工作方式出现实质性问题的比例更高，特别是影响他们的运动、视觉、听力、思维和说话。我们刚刚结束了在澳大利亚和新西兰的一项大型硫酸镁临床试验，该试验是给可能过早分娩(怀孕30周前)的母亲服用的。我们首次证明，硫酸镁能够将2岁幸存者的严重运动问题发生率减半，从6%降至3%。然而，我们不确定这一潜在的重要改进是否会在孩子们长大并达到学龄时转化为更好的结果。由于有许多在出生时给予治疗的例子被证明有一些短期好处，但却有很大的长期危害，我们必须尽可能确定，在一个小健康领域的任何进步都不会被其他健康领域的不利因素所抵消。我们计划评估我们早期临床试验中的1061名7-8岁的硫酸镁治疗幸存者，当时他们在学校。我们将评估他们的运动和大脑功能的其他重要区域，以及他们在学校的进步和总体健康和成长。如果我们发现硫酸镁疗法对这些儿童的学龄期健康有重要的改善，而没有任何实质性的抵消副作用，那么硫酸镁很可能会成为可能很早就分娩的母亲的标准疗法。这将减轻社区因过早出生而造成的疾病负担。

Despite recent major advances in care around the time of birth that have led to large increases in the survival rates for very preterm babies, the rate of adverse long-term health problems has not diminished in survivors, and remains too high compared with children not born very preterm. In particular they have higher rates of substantial problems with the way their brain works, particularly affecting their movement, vision, hearing, thinking and talking. We have just concluded a large clinical trial in Australia and New Zealand of magnesium sulphate which was given to mothers who were likely to deliver their baby too early (before 30 weeks of pregnancy). We have been able to show, for the first time, that magnesium sulphate was able to halve the rate of substantial problems with movement in 2 year old survivors, from 6% to 3%. However, we are not sure if this potentially important improvement will translate into better outcomes for the children as they grow older and reach school-age. As there are many examples of treatments given around the time of birth that have been shown to have some short-term benefits, but substantial long-term harms, we must be as certain as we can be that any advance in one small area of health is not counterbalanced by disadvantages in other health areas. We plan to assess the 1061 survivors from our earlier clinical trial of magnesium sulphate therapy at ages from 7-8 years, when they are at school. We will assess their movement and other important areas of their brain function, as well as their school progress and general health and growth. If we find important improvements in health at school-age of these children caused by magnesium sulphate therapy, without any substantial counterbalancing side-effects, magnesium sulphate will probably become standard therapy in mothers who are likely to deliver their baby very early. This will lead to a reduction in the burden of illness in the community caused by being born too early.