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The antenatal magnesium sulphate for fetal neuroprotection research cycle: beyond the meta-analysis

Date and Location

Session: 

O3.08.3

Date

Sunday 22 September 2013 - 15:30 - 17:00

Location

Presenting author and contact person

Presenting author

Emily Bain

Contact person

Emily Bain
Abstract text
Background: Well-designed and conducted randomised trials and systematic reviews provide reliable evidence of the effectiveness of treatments; however they form only part of a ‘research cycle’. While the 2009 Cochrane review ‘Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus,’ showed that magnesium sulphate given to women at risk of preterm birth can substantially reduce the risk of cerebral palsy for the children (RR 0.68, 95% CI 0.54-0.87; five trials, 6145 infants), real-life health impacts rely on the translation of this evidence beyond the meta-analysis. Objectives: To assess the impact of evidence, from Cochrane review, to clinical guidelines, translational research, implementation projects and further studies. Methods: Description of and comment on Australian and New Zealand knowledge translation processes and efforts to address research gaps post-publication of the 2009 Cochrane review. Results: Following publication of the 2009 Cochrane review, guidelines (including Bi-National) were developed. An ongoing project, ‘WISH’ is supporting 25 tertiary maternity centres for implementation, providing educational materials, assisting audit and feedback, and assessing local individual and system level barriers, including attitudes and motivation, supports, resources and processes. Addressing identified research gaps, the MAGENTA and IRIS randomised trials were designed and initiated. Preliminary audit results suggest appropriate magnesium sulphate administration for neuroprotection has increased in many tertiary settings; from almost zero to over 80% in two years at lead hospitals. Conclusions: The magnesium sulphate story highlights that a Cochrane review alone does not ensure the translation of evidence into practice. While active implementation has increased uptake and assisted movement through this cycle of research, health outcomes, such as survival free of cerebral palsy, need to be fully assessed. The research cycle has begun a new rotation, with unanswered questions, such as those relating to benefits of treatment at later gestational ages, being addressed.