MAGNESIUM SULFATE IN SEVERE PERINATAL ASPHYXIA: A RANDOMIZED, PLACEBO-CONTROLLED TRIAL

OBJECTIVE
The goal was to study whether postnatal

magnesium sulfate infusion could improve neurologic outcomes at discharge for term neonates with severe perinatal asphyxia.

METHODS
Forty term (37 weeks of gestation) neonates with severe perinatal asphyxia were studied in a

prospective, longitudinal, placebo-controlled trial. Patients were assigned randomly to receive either 3 doses of magnesium sulfate infusion at 250 mg/kg per dose (1 mL/kg per dose) 24 hours apart (treatment group) or 3 doses of normal saline infusion (1 mL/kg per dose) 24 hours apart (placebo group). Both groups also received supportive care according to the unit protocol for perinatal asphyxia.

RESULTS
In the treatment group, moderate encephalopathy was present in

35% (7 of 20) of the patients and severe encephalopathy in 65% (13 of 20) of patients at admission. In the placebo group, 40% (8 of 20) of patients had moderate encephalopathy and 60% (12 of 20) of patients had severe encephalopathy. The mean serum magnesium concentration in the treatment group remained at 1.2 mmol/L for 72 hours after the first infusion. At discharge, 22% (4 of 18) of infants in the treatment group had neurologic abnormalities, compared with 56% (10 of 18) of infants in the placebo group. Also, neuroimaging (head computed tomography) performed on day 14 yielded abnormal findings for fewer infants in the treatment group than in the placebo group (16% vs 44%). Infants in the treatment group were more likely to be receiving oral feedings (sucking) at discharge than were those in the placebo group (77% vs 37%). Good short-term outcomes at discharge occurred for 77% of the patients in the treatment group, compared with 37% of the patients in the placebo group.

CONCLUSION
Postnatal magnesium sulfate treatment improves neurologic outcomes at discharge for

term neonates with severe perinatal asphyxia.

PROSPECTIVE STUDY OF ALCOHOL CONSUMPTION AND METABOLIC SYNDROME

BACKGROUND
Alcohol consumption is related to the

prevalent metabolic syndrome. Few studies have evaluated the effects of alcohol consumption on the development of metabolic syndrome.

DESIGN
This was a prospective cohort study of 3833

male and female Koreans aged 40-69 y and free of the metabolic syndrome at baseline. Information on alcohol consumption was obtained periodically from intervieweradministered questionnaires. Incident cases of the metabolic syndrome were identified by biennial health examinations during 4 y of follow-up between 2003 and 2006.

RESULTS
Compared with nondrinkers, the multivariate relative risk [RR (95% CI)] of the metabolic

syndrome for very light drinkers consuming 0.1 to 5 g of alcohol per day (g/d) was 1.06 (0.71, 1.58), that for light drinkers consuming 5.1 to 15 g/d was 1.13 (0.69, 1.83), that for moderate drinkers consuming 15.1 to 30 g/d was 1.25 (0.75, 2.09), and that for heavy drinkers consuming 30 g/d was 1.63 (1.02, 2.62). All individual components of the metabolic syndrome were significantly associated with heavy drinking, particularly among heavy liquor drinkers.

CONCLUSION
Heavy drinking, in particular among liquor

drinkers, is associated with an increased risk of the metabolic syndrome by influencing its components. Further data are warranted to clarify the association between drinking minimal alcohol and the metabolic syndrome as well as the beverage-specific association for drinking beer or wine.

THE ASSOCIATION BETWEEN RECIPIENT ALCOHOL DEPENDENCY AND LONG-TERM GRAFT AND RECIPIENT SURVIVAL

BACKGROUND
The causative role of alcohol consumption in

renal disease is controversial, and its effect on renal graft and recipient survival has not been previously studied.

METHODS
We analysed the association between pretransplant [at the

time of end-stage renal disease (ESRD) onset] alcohol dependency and renal graft and recipient survival. The United States Renal Data System (USRDS) records of kidney transplant recipients 18 years or older transplanted between 1

January 1995 and 31 December 2002 were examined. We used

KaplanMeier analysis and Cox regression models adjusted for covariates to analyse the association between pre-transplant

alcohol dependency and graft and recipient survival.

RESULTS
In an entire study cohort of 60 523, we identified 425 patients

with a history of alcohol dependency. Using Cox models, alcohol dependency was found to be associated with increased risk of death-censored graft failure [hazard ratio (HR) 1.38, P<0.05] and increased risk of transplant recipient

death (HR 1.56, P<0.001). Subgroup analysis demonstrated an

association of alcohol-dependency with recipient survival and death-censored graft survival in males (but not in females),

and in both white and nonwhite racial subgroups.

CONCLUSION
We concluded that alcohol dependency at the

time of ESRD onset is a risk factor for renal graft failure and recipient death