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Estradiol y Progesterona
El estradiol tiene un efecto neuroprotector receptor depen-
diente (genómico y no genómico) o receptor independiente.
Induce el crecimiento dendrítico y axonal, promueve el
desarrollo de sinapsis y la integración de la corteza cerebral.
Además tiene propiedades antioxidantes (52).
La progesterona reduce el edema celular post isquémico,
al mantener la integridad de la barrera hematocerebral
Melatonina
Es un antioxidante con efectos antiinflamatorios y anti
apoptóticos. La administración materna en animales
puede reducir el riesgo de discapacidad neurosensorial,
incluyendo parálisis cerebral y muerte, en fetos prema-
turos y de término (53).
Creatina
Es un aminoácido que se obtiene de pescados y carnes
o por síntesis endógena desde arginina, glicina y metio-
nina. En estudios animales mediante el aporte dietario de
la madre durante el embarazo, tendría un efecto neuro-
protector, al disminuir el riesgo de resultados adversos en
el neurodesarrollo, como la parálisis cerebral (54).
REFERENCIAS BIBLIOGRáFICAS
1. Rosenbaum P, Paneth N, Leviton A et al. A report: the definition
and classification of cerebral palsy April 2006.Dev Med Child
Neurol Suppl. 2007 Feb;109:8-14.
2. Nelson KB, Grether JK. Causes of cerebral palsy. Curr Opin
Pediatr 1999;11:487-91.
3. Moster D, Lie RT, Markestad T. Long-term medical and social
consequences of preterm birth. N Engl J Med 2008; 359:262–
273.
4. Allen M. Neurodevelopmental outcomes of preterm infants.
Current Opinion in Neurology 2008; 21:123–128.
5. Alison G. Cahilla A., Stouta M., and Caugheyb A. Intrapartum
magnesium for prevention of cerebral palsy: continuing
controversy? Current Opinion in Obstetrics and Gynecology
2010; 22:122–127.
6. Volpe J., Neurology of the Newborn, WB Saunders, 1995.
7. Van de Bor M, Verloove-Vanhorick SP, Brand R, Keirse
MJ, Ruys JH. Incidence and prediction of periventricular-
intraventricular hemorrhage in very preterm infants. J Perinat
Med 1987;15:333-9.
8. Leviton A, Kuban KC, Pagano M, Brown ER, Krishnamoorthy KS,
Allred EN. Maternal toxemia and neonatal germinal matrix
hemorrhage in intubated infants less than 1751 g. Obstet
Gynecol 1988;72:571-6.
9. Kuban KC, Leviton A, Pagano M, Fenton T,Strassfeld R, Wolff
M. Maternal toxemia is associated with reduced incidence
of germinal matrix hemorrhage in premature babies. J Child
Neurol 1992;7:70-6.
10. Nelson KB, Grether JK. Can magnesium sulfate reduce the risk
of cerebral palsy in very low birthweight infants? Pediatrics
1995;95:263-9.
11. Mittendorf R, Dambrosia J, Pryde PG, et al. Association
between the use of antenatal magnesium sulfate in preterm
La autora declara no tener conflictos de interés, en relación a este artículo.
labor and adverse health outcomes in infants. Am J Obstet
Gynecol 2002; 186:1111-8.
12. Crowther CA, Hiller JE, Doyle LW, Haslam RR; Australasian
Collaborative Trial of Magnesium Sulphate (ACTOMg SO4)
Collaborative Group: Effect of magnesium sulfate given
for neuroprotection before preterm birth: a randomized
controlled trial. JAMA 2003; 290:2669-76.
13. Magpie Trial Follow-Up Study Collaborative Group: The
Magpie Trial: a randomized trial comparing magnesium
sulphate with placebo for pre-eclampsia. Outcome for
children at 18 months. BJOG 2007; 114:289-99.
14. Marret S, Marpeau L, Zupan-Simunek V. et al. PREMAG trial
group: Magnesium sulphate given before very-preterm birth
to protect infant brain: the randomized controlled PREMAG
trial. BJOG 2007; 114:310-8.
15. Rouse DJ, Hirtz DG, Thom E., et al. A randomized, controlled
trial of magnesium sulfate for the prevention of cerebral
palsy. N Engl J Med 2008;359:895-905.
16. DoyleLW,Crowther CA, Middleton P, Marret S, Rouse D.
Magnesium sulphate for women at risk of preterm birth for
neuroprotection of the fetus. Cochrane Database Syst Rev
2009:CD004661.
17. Conde-Agudelo A., Romero R. Antenatal magnesium sulfate
for the prevention of cerebral palsy in preterm infants less than
34 weeks’ gestation:a systematic review and metaanalysis.
Am J Obstet Gynecol June 2009; 595-609.
18. Constantine M., Weiner S. Effects of Antenatal Exposure
to Magnesium Sulfate on Neuroprotection and Mortality
in Preterm Infants A Meta-analysis. Obstet Gynecol
2009;114:354–64.
19. Elliott J., Lewis D., Morrison J., Garite T. In Defense of
Magnesium Sulfate.Obstet Gynecol 2009;113:1341–8.
[Prevención prenatal de daño neurológico en prematuro extremo - Dra. Lorena Quiroz]