How serum magnesium level is related to severity of asphyxia


  • Atul Kumar Khare Department of General Surgery, GMC, Shahdol, Madhya Pradesh, India
  • Kirti Singh Department of Obstetrics and Gynaecology, GMC, Shahdol, Madhya Pradesh, India
  • Ashish Paliwal Department of Pediatrics Surgery, SMS Medical College Jaipur, Rajasthan, India
  • Richa Sharma SRVS Medical College Shivpuri, Madhya Pradesh, India



Perinatal asphyxia, Neonates, Moderated asphyxia


Background: Perinatal asphyxia is a most common cause of neonatal death. Magnesium, the second most common intracellular cation, may play a role in neuroprotection.

Methods: This observational study was undertaken in the Department of Gynecology and Pediatrics in GMC, Shahdol from January 2021 to June 2023. The term babies were included with congenital anomaly, diabetic mother, IUGR, and mother receiving magnesium therapy during labour were excluded. Data analysis was conducted using IBM SPSS statistical software (version 22.0).

Results: Out of 46 newborns, mild to moderated asphyxia and severe asphyxia were presenting 32 (69.6%) and 14 (30.4%) cases respectively. HIE-I were 20 (43.5%), HIE II-16 (34.8%) and HIE III-10 (21.7%). The mean serum magnesium level in neonates with mild to moderate asphyxia was 2.1±0.3 and with severe asphyxia 1.5±0.5 respectively (p=0.001). Serum magnesium was significantly low in severe birth asphyxia as compared to mild to moderate (p=0.001) and level was significantly low in HIE stage 3. The difference in serum magnesium between HIE 1 and 3 and HIE 2 and HIE 3 was statistically significant (p=0.003 and p=0.009, respectively). A significant correlation between serum magnesium and Apgar score at 1 minute (Pearson’s correlation coefficient, r=0.518, p=0.001) and score at 5 minutes was also statistically significant (Pearson’s correlation coefficient, r=0.379, p=0.009).

Conclusions: Neonates with severe asphyxia and HIE- grade III have significant hypomagnesemia. Asphyxia can lead to hypomagnesemia, and it is recommended to evaluate levels of magnesium in neonates with asphyxia as a routine test.


Hansen AR, Soul JS. Perinatal asphyxia and hypoxic ischemic encephalopathy. In: Cloherty JP, Eichenward E, Stark AR, eds. Manual of neonatal care. 6th edition, Philadephia: Lippincott Williams and Wilkins; 2008: 711-28.

Carlo WA. The high-risk infant. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, Behrman RE, eds. Nelson textbook of pediatrics. 19th ed. Philadelphia: PA Saunders; 2011: 569-73.

Sexon WR, Sexson SB, Rawson JE, Brann AW. The multisystem involvement of asphyxiated newborn. Pediatr Res. 1976;10:432.

Scott H. Outcome of very severe birth asphyxia. Arch Dis Child. 1976;51:712.

Robertson CMT, Perlman M. Follow-up of the term infant after hypoxic ischemic encephalopathy. Paediatr Child Health. 2006;11:278-82.

ACOG Task Force on Neonatal Encephalopathy and Cerebral Palsy. Neonatal encephalopathy and cerebral palsy: defining the pathogenesis and pathophysiology. Washington, DC: American College of Obstetricians and Gynecologists; 2003.

NNPD network. National Neonatal Perinatal Database-report for the year 2002-2003. New Delhi: NNF NNPD network; 2005.

Wu Y. Brain injury in newborn babies: we can’t afford to get it wrong. Ann Neurol. 2012;72:151.

Calvert JW. Pathophysiology of a hypoxic-ischemic insult during the perinatal period: Neurol Res. 2005;27:246-60.

Douglas-Escobar M, Weiss MD. Hypoxic-ischemic encephalopathy: a review for the clinician. JAMA Pediatr. 2015;169(4):397-403.

Danbolt NC. Glutamate uptake. Prog Neurobiol. 2001;65(1):1-105.

Johnston MV. Excitotoxicity in neonatal hypoxia. Ment Retard Dev Disabil Res Rev. 2001;7(4):229-34.

Delivoria-Papadopoulos M, Mishra OP. Mechanisms of cerebral injury in perinatal asphyxia and strategies for prevention. J Pediatr. 1998;132:30-4.

Morrisett RA, Mott DD, Lewis DV, Wilson WA, Swartzwelder HS. Reduced sensitivity of the N-methyl-D-aspartate component of synaptic transmission to magnesium in hippocampal slices from immature rats. Dev Brain Res. 1990;56:257-62.

Johnston MV. Cellular alterations associated with perinatal asphyxia. Clin invest Med. 1993;16:122-32.

Greenamyre JT, Porter RHP. Anatomy and Physiology of glutamate in the CNS. Neurology. 1994;44:7-12.

Hoffman DJ, Marro PJ, McGowan JE, Mishra OP, Delivoria-Papadopoulos M. Protective effect of MgSO4 infusion on NMDA receptor binding characteristics during cerebral cortical hypoxia in the newborn piglet. Brain Res. 1994;644:144-9.

Nowak L, Bregestovski P, Ascher P, Herbet A, Prochiantz A. Magnesium gates glutamate-activated channels in mouse central neurones. Nature. 1984;307(5950):462-5.

Zaman R, Mollah AH, Chowdhury MMR, Yeasmin S, Chowdhury AS, Saha D. Serum magnesium and calcium status among term asphyxiated newborns with moderate to severe hypoxic-ischemic encephalopathy (HIE). J Dhaka Med Coll. 2017;26(2):148-52.

Kumar DV, Yelamali BC, Ramesh P. Serum calcium and magnesium levels in predicting short term outcome of term neonates with hypoxic ischemic encephalopathy. Res Gate. 2018;7(1):44-7.

Khalessi N, Mazouri A, Bassirnia M, Afsharkhas L. Comparison between serum magnesium levels of asphyxiated neonates and normal cases. Med J Islam Repub Iran. 2017;31:19.

Gandhi K, Kumar Singh A, Mehta A, Sharma B, Tiwari H. Association between serum magnesium level and outcome in birth asphyxia. Int J Pediatr Res. 2020;7(7).

Pius S, Bello M, Ambe JP, Machoko Y, Clement AY, Genesis R, et al. Magnesium sulphate administration and early resolution of hypoxic ischemic encephalopathy in severe perinatal asphyxia. Open J Pediatr. 2019;9:89-102.

Ilves P, Kiisk M, Soopo T, Talvik T. Serum total magnesium and ionized calcium concentrations in asphyxiated term newborns with hypoxic- ischemic encephalopathy. Acta Paediatr. 2000;89:680-5.

Bhat MA, Charoo BA, Bhat JI, Ahmad SM, Ali SW, Masood-ul-Hassan Mufti MD. Magnesium sulfate in severe perinatal asphyxia: a randomized, placebo-controlled trial. Am Acad Pediatr. 2009;123:764.

Saha D, Ali MA, Haque MA, Ahmed MS, Sutradhar PK, Latif T, et al. Association of hypoglycemia, hypocalcemia, and hypomagnesemia in neonates with perinatal asphyxia. Mymensingh Med J. 2015;24(2):244-50.

Romero A, Nannig P. Hypomagnesemia in newborns with hypoxic ischemic encephalopathy and whole-body hypothermia. Rev Chil Pediatr. 2020;91(1):116-21.

Khalessi N, Khosravi N, Mirjafari M, Afsharkhas L. Plasma ammonia levels in newborns with asphyxia. Iran J Child Neurol. 2016;10(1):42-6.

Foley MA, Kamel HM, Mounir SM, Habeb SN. Role of serum level of neurometals; copper, zinc and magnesium in neonates with hypoxic ischemic encephalopathy. Clin Lab. 2016;62(9):1633-41.

Mia AH, Hoque MM, Jahan I, Khan FH, Akter KR, Chowdhury M. Outcome of different grade of perinatal asphyxia in a tertiary care hospital. DS (Child) H J. 2010;26(2):87-9.

Hossain MM, Mannan MA, Yeasmin F, Shaha CK, Rahman MH, Shahidullah M. Short-term outcome of magnesium sulfate infusion in perinatal asphyxia. Mymensingh Med J. 2013;22(4):727-35.






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