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To the Editor: In their study of magnesium sulfate given for neuroprotection before preterm birth, Dr Crowther and colleagues¹ concluded that "combined death or substantial gross motor dysfunction was significantly reduced in the magnesium group." Although composite outcomes can compensate for the low frequency of several individual outcomes, they are thus heterogeneous and sometimes difficult to interpret. We therefore question the definition and usefulness of this composite outcome. The individual components of these composite outcomes are vastly different from one another and do not share the same economical, social, or clinical value. Thus, it is difficult for clinicians to know how to counsel patients about the benefit(s) of this intervention.

The authors concluded that "magnesium sulfate given to women immediately before very preterm birth may improve important pediatric outcomes." Perhaps a better conclusion would have been that this trial was a negative study because magnesium sulfate was not effective in . . . [Full Text of this Article]

Cande V. Ananth, PhD, MPH
cande.ananth@umdnj.edu

Anthony M. Vintzileos, MD
Department of Obstetrics, Gynecology and Reproductive Sciences
University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School
New Brunswick

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