Effects of Antenatal Steroids with Magnesium Sulphate on Intraventricular Hemorrhage and Periventricular Leukomalacia in Neonates Born below 32 Weeks of Gestation


  • Dhaval Patel CU Shah Medical College, Surendra Nagar, Gujarat, India
  • Asit Vora CU Shah Medical College, Surendra Nagar, Gujarat, India
  • Parth Goyal CU Shah Medical College, Surendra Nagar, Gujarat, India
  • Pankaj Dubey CU Shah Medical College, Surendra Nagar, Gujarat, India




Intraventricular Hemorrhage, Periventricular Leukomalacia, Steroid, Magnesium sulphate


Introduction: The most important acquired brain injuries in very and extremely preterm infants born in developing Country are periventricular-Intraventricular haemorrhages and diffuse white matter injury. Antenatal corticosteroids play a crucial role in its development. A study was conducted to determine effects of antenatal steroids along with magnesium sulphate on Intraventricular Hemorrhage and Periventricular Leukomalacia in preterm neonates.

Methodology: A retrospective prospective cohort study conducted among premature newborn babies admitted in the hospital. Based on the antenatal medication subjects were divided in to three groups: Group 1: No Steroid and No MgsO4 in antenatal period; Group 2: Received complete and incomplete course of antenatal steroid; and Group 3: Received complete course of antenatal steroid and MgSO4. The Occurrence of IVH and/or PVL in the neonates during hospital stay in all 3 groups.

Results: Among the 144 cases, 8 patients had IVH and 1 had PVL. No intervention group (No antenatal steroids/ antenatal MgSo4) had highest chances of development of IVH/PVL. Significantly lower rate of IVH/PVL recorded in ‘Steroid and MgSO4’ group compared to only ‘Steroid’ group. The chances of development of RDS, BPD and NEC in no intervention group (No antenatal steroids and antenatal MgSo4) was significantly higher compared to steroid and and MgSO4 group and Steroid only group.

Conclusion: This study confirmed that antenatal steroids when used along with antenatal magnesium sulphate to deliver preterm babies reduce IVH and white matter brain injury significantly.


Frank van Bel, Josine Vaes, Floris Groenendaal. Prevention, Reduction and Repair of Brain Injury of the Preterm Infant. Front Physiol. 2019; 10: 181. Doi: https://doi.org/10.3389/fphys.2019.00181 PMid:30949060 PMCid:PMC6435588

Khanafer-Larocque I, Soraisham A, Stritzke A, Al Awad E, Thomas S, Murthy P, Kamaluddeen M, Scott JN, Mohammad K. Intraventricular hemorrhage: risk factors and association with patent ductusarteriosus treatment in extremely preterm neonates. Frontiers in pediatrics. 2019 Oct 22;7:408. Doi: https://doi.org/10.3389/fped.2019.00408 PMid:31696098 PMCid:PMC6817605

Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatric research. 2010; 67(1):1-8. Doi: https://doi.org/10.1203/PDR.0b013e3181c1b176 PMid:19816235 PMCid:PMC2799187

Jain NJ, Kruse LK, Demissie K, Khandelwal M. Impact of mode of delivery on neonatal complications: trends between 1997 and 2005. The journal of maternal-fetal & neonatal medicine. 22(6):491-500. Doi: https://doi.org/10.1080/14767050902769982 PMid:19504405

McCrea HJ, Ment LR. The diagnosis, management, and post-natal prevention of intraventricularhemorrhage in the preterm neonate. Clinics in perinatology. 2008; 35(4):777-792. vii. Doi: https://doi.org/10.1016/j.clp.2008.07.014 PMid:19026340 PMCid:PMC2901530

Pinto-Martin JA, Whitaker AH, Feldman JF, Van Rossem R, Paneth N. Relation of cranial ultrasound abnormalities in low-birthweight infants to motor or cognitive performance at ages 2, 6, and 9 years. Dev Med Child Neurol. 1999; 41(12):826-833. Doi: https://doi.org/10.1017/S0012162299001644 PMid:10619281

Liggins GC, Howie RN. A controlled trial of antepartum gluco-corticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972; 50(4):515-525. Doi: https://doi.org/10.1542/peds.50.4.515

Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev2006; 356 :CD004454. Doi: https://doi.org/10.1002/14651858.CD004454.pub2

Kuban KC, Leviton A, Pagano M, Fenton T, Strassfeld R, Wolff M. Maternal toxemia is associated with reduced incidence of germinal matrix hemorrhage in premature babies. J Child Neurol. 1992;7(1):70-6. Doi: https://doi.org/10.1177/088307389200700113 PMid:1552156

Paneth N, Jetton J, Pinto-Martin J, Susser M. Magnesium sulfate in labor and risk of neonatal brain lesions and cerebral palsy in low birth weight infants. Pediatr. 1997;99(5). Doi: https://doi.org/10.1542/peds.99.5.e1 PMid:9113958

Crowther CA, Middleton PF, Wilkinson D, Ashwood P, Haslam R. Magnesium sulphate at 30 to 34 weeks' gestational age: neuroprotection trial (MAGENTA)-study protocol. BMC Preg-nancy Childbirth. 2013;13(1):91. Doi: https://doi.org/10.1186/1471-2393-13-91 PMid:23570677 PMCid:PMC3636106

Wei JC, Catalano R, Profit J, Gould JB, Lee HC. Impact of an-tenatal steroids on intraventricular hemorrhage in verylow- birth weight infants. J Perinatol. 2016;36(5):352-356. Doi: https://doi.org/10.1038/jp.2016.38 PMid:27010109 PMCid:PMC4844862

Caritis S, Sibai B, Hauth J, Lindheimer M, VanDorsten P, Klebanoff M, Thom E, Landon M, Paul R, Miodovnik M, Meis P. Predictors of pre-eclampsia in women at high risk. Ameri-can journal of obstetrics and gynecology. 1998 Oct 1;179(4):946-51. Doi: https://doi.org/10.1016/S0002-9378(98)70194-2 PMid:9790376

Sibai BM. Diagnosis and management of gestational hyper-tension and preeclampsia. Obstetrics & Gynecology. 2003 Jul 1;102(1):181-92. Doi: https://doi.org/10.1016/S0029-7844(03)00475-7 PMid:12850627

Berg CJ, Chang J, Callaghan WM, Whitehead SJ. Pregnancy-related mortality in the United States, 1991-1997. Obstetrics & Gynecology. 2003 Feb 1;101(2):289-96. Doi: https://doi.org/10.1097/00006250-200302000-00015 PMid:12576252

Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. American journal of obstet-rics and gynecology. 1998 Nov 1;179(5):1359-75. Doi: https://doi.org/10.1016/S0002-9378(98)70160-7 PMid:9822529

Gembruch U, Gortner L. Perinatal aspects of preterm intrau-terine growth restriction. Ultrasound ObstetGynecol 1998; 11: 233-9. Doi: https://doi.org/10.1046/j.1469-0705.1998.11040233.x PMid:9618842

Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Golan A. Morbidity and mortality among very-low-birth-weight neo-nates with intrauterine growth restriction. Am J ObstetGynecol 2000; 182: 198-206. Doi: https://doi.org/10.1016/S0002-9378(00)70513-8 PMid:10649179

Ment LR, Vohr B, Oh W, Scott DT, Allan WC, Westerveld M, Duncan CC, Ehrenkranz RA, Katz KH, Schneider KC, Makuch RW. Neurodevelopmental outcome at 36 months' corrected age of preterm infants in the Multicenter Indomethacin Intra-ventricular Hemorrhage Prevention Trial. Pediatrics 1996; 98: 714-8. Doi: https://doi.org/10.1542/peds.98.4.714 PMid:8885951

Baschat AA, Gembruch U, Harman CR. The sequence of changes in Doppler and biophysical parameters as severe growth restriction worsens. Ultrasound Obstet Gynecol 2001; 18: 571-7. Doi: https://doi.org/10.1046/j.0960-7692.2001.00591.x PMid:11844191

Baschat AA, Harman CR. Antenatal surveillance on fetal growth restriction. Curr Opin Obstet Gynaecol 2001; 13: 161-8. Doi: https://doi.org/10.1097/00001703-200104000-00011 PMid:11315871

Gosling RG, King DH. Ultrasound angiology. In: Marcus AW, Adamson L, eds. Arteries and Veins. Edinburgh: Churchill Livingstone, 1975: 61-98.

Wladimiroff JW, Tonge HM, Stewart PA. Doppler ultrasound assessment of cerebral blood flow in the human fetus. Br J Obstet Gynaecol 1986; 93: 471-5. Doi: https://doi.org/10.1111/j.1471-0528.1986.tb08656.x PMid:3518788

Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cere-bralumbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992; 79: 416-20. Doi: https://doi.org/10.1097/00006250-199203000-00018 PMid:1738525

Al Ghazali W, Chita SK, Chapman MG, Allan LD. Evidence of redistribution of cardiac output in asymmetrical growth retar-dation. Br J Obstet Gynaecol 1987; 96: 697-704. Doi: https://doi.org/10.1111/j.1471-0528.1989.tb03285.x PMid:2803992

Behrman RE, Kliegman RM, Jenson HB. Nelson textbook of pediatrics. 17th. WB Saunders Co; 2003.

Fanarhof AA, Martin RJ. 6th ed. Philadelphia: Lippincott-Raven; 1997. Neonatal - perinatal medicine: diseases of the fetus and infant; pp. 264-284.

Shankaran S, Bauer CR, Bain R, Wright LL, Zachary J. Rela-tionship between antenatal steroid administration and grades III and IV intracranial hemorrhage in low birth weight infants. The NICHD Neonatal Research Network. American journal of obstetrics and gynecology. 1995;173(1):305-312. Doi: https://doi.org/10.1016/0002-9378(95)90219-8 PMid:7631710




How to Cite

Patel, D., Vora, A., Goyal, P., & Dubey, P. (2024). Effects of Antenatal Steroids with Magnesium Sulphate on Intraventricular Hemorrhage and Periventricular Leukomalacia in Neonates Born below 32 Weeks of Gestation. National Journal of Medical Research, 14(01), 4–10. https://doi.org/10.55489/njmr.14012024987



Original Research Articles