Cerebral lactate and N-acetyl-aspartate/choline ratios in asphyxiated full-term neonates demonstrated in vivo using proton magnetic resonance spectroscopy.
The purpose of this study was to test the hypothesis that a high lactate signal and a low N-acetyl-aspartate/choline ratio in neonates with postasphyxial encephalopathy indicated a high chance of an adverse outcome in vivo when proton magnetic resonance spectroscopy was used. Twenty-one full-term asphyxiated neonates were examined at a mean postnatal age of 7.1 d. Five patients died, and five survivors had handicaps. Eleven of the 16 survivors (seven without handicaps and four with handicaps) had a second examination at 3 mo of age. After magnetic resonance imaging, spectra were obtained at 1.5 tesla. A 20-mm-thick slice was selected through the basal ganglia. After optimizing the B-0 field, we used a double spin-echo pulse sequence (90-180-180 degrees) with a time to repeat of 2000 ms and a time to echo of 272 ms. Two-dimensional spectroscopic imaging was performed by 32 x 32 phase encoding steps in two directions in a 225-mm field of view, resulting in 1-mL volumes, followed by computerized processing. Neuromotor development was examined at 6 wk, 3 mo, and every 3 mo thereafter. Lactate resonances were seen only in the five patients with grade 3 postasphyxial encephalopathy. Lactate was distributed diffusely (n = 4), or localized in areas of infarction (n = 1). N-acetyl-aspartate/choline ratios were significantly lower in the patients with an adverse outcome than in the survivors without handicaps, both neonatally (p < 0.005, Wilcoxon's rank sum test) and at 3 mo (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Groenendaal
F
F
Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Veenhoven
R H
RH
van der Grond
J
J
Jansen
G H
GH
Witkamp
T D
TD
de Vries
L S
LS
D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001238:Asphyxia Neonatorum / Q000378:metabolism* / Q000473:pathology; D001921:Brain / Q000378:metabolism*; D002794:Choline / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007773:Lactates / Q000378:metabolism*; D019344:Lactic Acid; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D009420:Nervous System / Q000254:growth & development / Q000473:pathology; D011379:Prognosis
D007773:Lactates; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D002794:Choline