Prediction of adverse outcome with cerebral lactate level and apparent diffusion coefficient in infants with perinatal asphyxia.
OBJECTIVE
To compare the predictive value for adverse outcome of quantitative cerebral lactate level and of apparent diffusion coefficient (ADC) in infants with perinatal asphyxia in the early postnatal period.


METHODS
Lactate-choline ratios determined with proton magnetic resonance (MR) spectroscopy and ADC determined with diffusion MR imaging in basal ganglia and thalami in 26 full-term neonates (age range, 1-10 days) were compared with severity of acute hypoxic-ischemic encephalopathy and long-term clinical outcome. Differences in metabolites between outcome groups were evaluated with the nonparametric Kruskal-Wallis test and the Dunn test. Logistic regression was performed to examine the predictive value of each metabolite for differentiating normal from abnormal or fatal clinical outcome. The likelihood ratio test was used to assess the statistical significance of each metabolite.


RESULTS
Logistic regression confirmed that lactate-choline ratio could be used to differentiate normal (n = 5) from abnormal (n = 14) or fatal (n = 6) outcome (P <.001). The probability of an adverse outcome exceeded 95% for a lactate-choline ratio of 1.0. Even when analyses were restricted to the early postnatal period, lactate-choline ratio was still a significant predictor of adverse outcome (P =.001). Although ADC images were useful in clinical examination of these infants, quantitative ADCs were not predictive of outcome (P =.82).


CONCLUSIONS
Higher lactate-choline ratios in basal ganglia and thalami of infants with perinatal asphyxia were predictive of worse clinical outcomes. Absolute ADC in the same brain regions did not indicate a statistically significant relationship with clinical outcome. Cerebral lactate level is useful in identifying infants who would benefit from early therapeutic intervention.
Zarifi
Maria K
MK
Departments of Radiology, Children's Hospital, Harvard Medical School, Boston, Mass 02114, USA.
Astrakas
Loukas G
LG
Poussaint
Tina Young
TY
Plessis Ad
Adré du
Ad
Zurakowski
David
D
Tzika
A Aria
AA
D001238:Asphyxia Neonatorum / Q000378:metabolism*; D001921:Brain / Q000378:metabolism*; D001923:Brain Chemistry; D002794:Choline / Q000378:metabolism; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019344:Lactic Acid / Q000378:metabolism*; D016015:Logistic Models; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D011237:Predictive Value of Tests
D019344:Lactic Acid; D002794:Choline