Comparative mortality and neurological outcomes in term newborns with severe perinatal asphyxia treated with combined magnesium sulphate and erythropoietin or magnesium sulfate alone
Keywords:
Perinatal asphyxia, Hypoxic-ischaemic encephalopathy, Pharmacological Neuroprotection.Abstract
Background: Severe perinatal asphyxia (PA) remains a leading cause of neonatal mortality and long-term neurological disability in low- and middle income countries (LMICs) where therapeutic hypothermia is largely unavailable. Pharmacological neuroprotective agents may offer cost e f f e c t i v e a l t e r n a t i v e s . Methods: The institutional Ethics Committee approved the protocol. We conducted a prospective, randomized, controlled trial of erythropoietin and magnesium sulfate on term neonates with severe PA (hypoxic-ischemic encephalopathy [HIE] stages II–III) at the Federal Medical Centre, Asaba, Nigeria, in 2024. They were randomized to either MgSO₄ plus EPO (Group I, n = 50) or MgSO₄ alone (Group II, n = 50). Group II. The primary outcome was in-hospital 28-day mortality. Secondary outcomes included time to resolution of neurologic symptoms and neurological status a t 2 8 d a y s . Results: 130/ 1370 (9.4%) in hospital deliveries had PA; 598 of these were admitted. 205/ 803 (25.53%) total admissions to the Neonatal unit were outborn; 88 had PA. Mortality was significantly lower in group I (4%; 2/50) compared with group II (18%; 9/50, p = 0.025). Combination therapy resulted in faster seizure control (1.34 ± 1.61 vs 2.71 ± 2.23 days, p = 0.002), earlier recovery of: suck (4.7 vs 7.9 days, p = 0.014), grasp reflex (5.3 vs 8.5 days, p = 0.028), and tone normalization (16.1 vs 21.3 days, p = 0.037). Logistic regression identified low birth weight, low APGAR score, and out-of-hospital delivery as significant predictors o f m o r t a l i t y . Conclusion: Combination therapy with Erythropoietin significantly reduced mortality and improved neurological recovery in term neonates with severe PA. This combination could representa feasible, cost-effective alternative for LMICs.
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