Use of intravenous magnesium sulfate in addition to standard first-line treatment with inhaled/nebulised short-acting beta 2 agonist and systemic steroids in the management of acute asthma exacerbations in children: a systematic review and meta-analyses of randomised controlled trials
Bibliographic record
Abstract
Background The role of intravenous magnesium sulfate in asthma exacerbation is unclear. Aims To determine the efficacy and safety of intravenous magnesium sulfate in managing asthma exacerbation in children. Methods We searched MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and the Web of Science up to May 2024. We included randomised controlled trials and followed the international guidelines for conducting systematic reviews. Outcomes included morbidity, escalation of care, length of hospital stay, lung functions, adverse events, and mortality. Results Nine studies (total participants=473) were included. Hospitalisation rate and the need for non-invasive ventilation were less among the intravenous magnesium sulfate group (mean difference (MD)=0.70, 95% CI 0.54 to 0.90, I 2 7%, n=115) and (risk ratio (RR)=0.17, 95% CI 0.15 to 0.54, p=0.003, n=143), respectively. Asthma severity scores (MD=−0.18, 95% CI −1.35 to 0.98, I 2 2%, n=115), length of hospital stay (MD=−78.86, 95% CI −200.37 to 42.66, I 2 99%, n=284) and the need for invasive ventilation (RR=0.35, 95% CI 0.11 to 1.17, I 2 0%, n=237) were similar. There was no difference in the Paediatric Intensive Care Unit (PICU) admission rate (p=0.43 n=61). Peak expiratory flow improved in the intravenous magnesium group (p<0.001, n=20). No serious adverse events were reported. Conclusion We found low-certainty evidence that intravenous magnesium sulfate results in a lower hospitalisation rate and less need for non-invasive ventilation. Asthma scores, PICU admission, invasive ventilation and length of hospital stay were similar. While the evidence base is weak, the favourable safety profile suggests that intravenous magnesium sulfate can be considered a treatment for asthma exacerbations. PROSPERO registration number CRD42023405261.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.024 | 0.028 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".