title: Prognostic value of 1H-MRS in neonatal encephalopathy.
abstract: The aim of this study was to determine the prognostic value of proton magnetic resonance spectroscopy in neonatal encephalopathy. Studies were carried out in 11 consecutive term newborns with encephalopathy probably caused by hypoxic-ischemic injury. The clinical evaluation included pregnancy data, labor conditions, encephalopathy grade, presence of seizures, and necessity of antiepileptic drug therapy. Polygraphic recordings were obtained in all cases. Interest areas evaluated by spectroscopy were the basal ganglia and thalami. Among the cases, N-acetylaspartate/creatine, choline/creatine, and lactate/creatine ratios were calculated and related to the clinical variables, polygraphic recordings, and 6-month neurodevelopmental outcome. Abnormal follow-up occurred in 5 of 11 patients (45.4%) and was clearly related to an Apgar score <5 at 5 minutes (P = 0.003), encephalopathy grade (P = 0.02), early neonatal seizures (P = 0.02), and antiepileptic therapy (P = 0.01). No relationship was observed between spectroscopy results and polygraphic recordings profile. The lowest mean N-acetylaspartate/creatine ratio was observed in four of five patients with an adverse outcome and, although not statistically significant, demonstrated a clear trend to unfavorable follow-up (t test = 0.06). The choline/creatine ratios could not be related to follow-up in our sample. The most consistently observed abnormality on the spectra was the presence of the lactate peak in four of five patients with unfavorable outcome, with a high relative risk to determine evolution in the sample, relative risk 7.0 (chi2 = 0.01, 95% confidence interval = 1.1-42.9).
authors.affiliation: Division of Neurology and Clinical Neurophysiology Laboratory, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre, Brazil.
authors.forename: Luis Fernando Garcias
authors.initials: LF
authors.lastname: da Silva
authors.forename: João Rubião
authors.initials: JR
authors.lastname: Höefel Filho
authors.forename: Maurício
authors.initials: M
authors.lastname: Anés
authors.forename: Magda Lahorgue
authors.initials: ML
authors.lastname: Nunes
mesh_terms: D001034:Apgar Score; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001238:Asphyxia Neonatorum / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D001479:Basal Ganglia / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D007231:Infant, Newborn; D019344:Lactic Acid / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D017286:Polysomnography; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism; D011379:Prognosis; D011522:Protons; D012307:Risk Factors; D013788:Thalamus / Q000378:metabolism
chemical_list: D011522:Protons; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D003404:Creatinine; D003401:Creatine; D002794:Choline