title: Characterization of cerebral white matter damage in preterm infants using 1H and 31P magnetic resonance spectroscopy.
abstract: The biochemical characteristics of white matter damage (WMD) in preterm infants were assessed using magnetic resonance spectroscopy (MRS). The authors hypothesized that preterm infants with WMD at term had a persisting cerebral lactic alkalosis and reduced N-acetyl aspartate (NAA)/ creatine plus phosphocreatine (Cr), similar to that previously documented in term infants weeks after perinatal hypoxiaischemia (HI). Thirty infants (gestational age 27.9 +/- 3.1 weeks, birth weight 1,122 +/- 445 g) were studied at postnatal age of 9.8 +/- 4.1 weeks (corrected age 40.3 +/- 3.9 weeks). Infants were grouped according to the presence or absence of WMD on magnetic resonance (MR) images. The peak area ratios of lactate/Cr, NAA/Cr, myo-inositol/Cr, and choline (Cho)/Cr were measured from an 8-cm3 voxel in the posterior periventricular white matter (WM) using proton MRS. Intracellular pH (pHi) was calculated using phosphorus MRS. Eighteen infants had normal WM on MR imaging; 12 had WMD. For infants with WMD, lactate/Cr and myo-inositol/Cr were related (P < 0.01); lactate/Cr and pHi were not (P = 0.8). In the WMD group, mean lactate/Cr and myo-inositol/Cr were higher (P < 0.001, P < 0.05, respectively) than the normal WM group. There was no difference in the NAA/Cr, Cho/Cr, or pHi between the two groups, although pHi was not measured in all infants. These findings suggest that WMD in the preterm infant at term has a different biochemical profile compared with the term infant after perinatal HI.
authors.affiliation: Department of Pediatrics, Imperial College School of Medicine, London, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Robertson
authors.forename: J
authors.initials: J
authors.lastname: Kuint
authors.forename: T J
authors.initials: TJ
authors.lastname: Counsell
authors.forename: T A
authors.initials: TA
authors.lastname: Rutherford
authors.forename: A
authors.initials: A
authors.lastname: Coutts
authors.forename: I J
authors.initials: IJ
authors.lastname: Cox
authors.forename: A D
authors.initials: AD
authors.lastname: Edwards
mesh_terms: D001921:Brain / Q000378:metabolism* / Q000473:pathology*; D003401:Creatine / Q000378:metabolism; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007294:Inositol / Q000378:metabolism; D019344:Lactic Acid / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D010725:Phosphocreatine / Q000378:metabolism; D010758:Phosphorus; D011446:Prospective Studies; D011522:Protons; D012016:Reference Values
chemical_list: D011522:Protons; D010725:Phosphocreatine; D010758:Phosphorus; D019344:Lactic Acid; D007294:Inositol; D003401:Creatine