Evidence map›Paper›PMID 29325592›Full record

ArticleImplementation science : IS2018

MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP)-implementation of a national guideline in Canada.

Dane A De Silva, Anne R Synnes, Peter von Dadelszen, Tang Lee, Jeffrey N Bone, MAG-CP, CPN and CNN collaborative groups, Laura A Magee

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Implementation science : IS, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Inappropriate use of clinical practices in Canada: a systematic review.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2022
    Pooled it
  3. Pooled it
  4. Article
  5. International disparities in use of antenatal magnesium sulfate and antenatal steroids for the preterm baby.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Review
  6. Observational
  7. Implementation of antepartum preterm birth interventions: A scoping review.European journal of obstetrics & gynecology and reproductive biology: X · 2025
    Review
  8. Article
  9. Article
  10. Observational
  11. Article
  12. Review
  13. The complex aetiology of cerebral palsy.Nature reviews. Neurology · 2018
    Review
  14. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Dane A De SilvaDepartment of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
Anne R SynnesBC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada.
Peter von DadelszenDepartment of Women and Children's Health, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK.
Tang LeeDepartment of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
Jeffrey N BoneDepartment of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
MAG-CP, CPN and CNN collaborative groups
Laura A MageeDepartment of Women and Children's Health, St Thomas' Hospital, 10th Floor, North Wing, Westminster Bridge Road, London, SE1 7EH, UK. Laura.A.Magee@kcl.ac.uk.

Funding

CIHR FRN-115116CIHR MOP-115116
6 · The paper itself

Abstract

backgroundEvidence supports magnesium sulphate (MgSO4) for women at risk of imminent birth at < 32-34 weeks to reduce the likelihood of cerebral palsy in the child. MAGnesium sulphate for fetal neuroprotection to prevent Cerebral Palsy (MAG-CP) was a multifaceted knowledge translation (KT) strategy for this practice.

methodsThe KT strategy included national clinical practice guidelines, a national online e-learning module and, at MAG-CP sites, educational rounds, focus group discussions and surveys of barriers and facilitators. Participating sites contributed data on pregnancies with threatened very preterm birth. In an interrupted time-series study design, MgSO4 use for fetal neuroprotection (NP) was tracked prior to (Aug 2005-May 2011) and during (Jun 2011-Sept 2015) the KT intervention. Effectiveness of the strategy was measured by optimal MgSO4 use (i.e. administration when and only when indicated) over time, evaluated by a segmented generalised estimating equations logistic regression (p < 0.05 significant). Secondary outcomes included maternal effects and, using the Canadian Neonatal Network (CNN) database, national trends in MgSO4 use for fetal NP and associated neonatal resuscitation. With an anticipated recruitment of 3752 mothers over 4 years at Canadian Perinatal Network sites, we anticipated > 95% power to detect an increase in optimal MgSO4 use for fetal NP from < 5 to 80% (2-sided, alpha 0.05) and at least 80% power to detect any increases observed in maternal side effects from RCTs.

resultsSeven thousand eight hundred eighty-eight women with imminent preterm birth were eligible for MgSO4 for fetal NP: 4745 pre-KT (18 centres) and 3143 during KT (11 centres). The KT intervention was associated with an 84% increase in the odds of optimal use (OR 1.00 to 1.84, p < 0.001), a reduction in the odds of underuse (OR 1.00 to 0.47, p < 0.001) and an increase in suboptimal use (too early or at ≥ 32 weeks; OR 1.18 to 2.18, p < 0.001) of MgSO4 for fetal NP. Maternal hypotension was uncommon (7/1512, 0.5%). Nationally, intensive neonatal resuscitation decreased (p = 0.024) despite rising MgSO4 use for fetal NP (p < 0.001).

conclusionMultifaceted KT was associated with significant increases in use of MgSO4 for fetal NP, with neither important maternal nor neonatal risks.

Indexed as

NeuroprotectionCanadaCerebral PalsyChildFemaleHumansInfantInfant, NewbornMagnesium SulfateNeuroprotective AgentsPregnancyMagnesium SulfateNeuroprotective AgentsCerebral palsyFetal neuroprotectionImplementationInterrupted time-seriesKnowledge translationMagnesium sulphatePreterm birth

Identifiers

PMID29325592
PMCPMC5765609

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.