title: Brain metabolite levels assessed by lactate-edited MR spectroscopy in premature neonates with and without pentobarbital sedation.
abstract: OBJECTIVE
  Pentobarbital is known to affect cerebral metabolism; pentobarbital sedation is, however, frequently used for MR imaging and MR spectroscopy, especially in children. Accurate assessment of the brain metabolite levels is important, particularly in neonates with suspected brain injury. We investigated whether pentobarbital sedation has any effect on the ratios of spectral metabolites lactate, N-acetylaspartate, or choline in a group of premature neonates.
  
  
  METHODS
  MR spectroscopy was performed in 43 premature neonates, all with normal concurrent MR imaging and normal neurodevelopmental outcome at 12 months of age. Of those neonates, 14 (33%) required pentobarbital (Nembutal 1 mg/kg) sedation during MR spectroscopy; the remaining 29 neonates did not receive any sedation. Ratios of lactate, choline, and N-acetylaspartate were calculated in the basal ganglia, thalami, and corticospinal tracts and compared between those neonates with and without sedation.
  
  
  RESULTS
  Small amounts of brain lactate were detected in all of the premature neonates. The basal ganglia lactate/choline and lactate/N-acetylaspartate ratios were significantly lower, by 17% and 25% respectively, in the neonates with pentobarbital sedation compared with the age-matched neonates without sedation (P < .05). Sedation did not affect the lactate level in the thalami or the corticospinal tracts. The N-acetylaspartate/choline ratios were unaffected by pentobarbital sedation.
  
  
  CONCLUSIONS
  Pentobarbital sedation is associated with lower lactate/choline and lactate/N-acetylaspartate ratios in the basal ganglia of premature neonates, as determined by proton MR spectroscopy. Investigators should be aware of this phenomenon for accurate interpretation of their MR spectroscopy results.
authors.affiliation: Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA. jane.wang@radiology.ucsf.edu
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Wang
authors.forename: D B
authors.initials: DB
authors.lastname: Vigneron
authors.forename: S P
authors.initials: SP
authors.lastname: Miller
authors.forename: P
authors.initials: P
authors.lastname: Mukherjee
authors.forename: N N
authors.initials: NN
authors.lastname: Charlton
authors.forename: Y
authors.initials: Y
authors.lastname: Lu
authors.forename: A J
authors.initials: AJ
authors.lastname: Barkovich
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000032:analysis; D001479:Basal Ganglia / Q000737:chemistry; D001923:Brain Chemistry / Q000187:drug effects*; D002794:Choline / Q000032:analysis; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism*; D019344:Lactic Acid / Q000032:analysis; D009682:Magnetic Resonance Spectroscopy; D010424:Pentobarbital / Q000494:pharmacology*; D011712:Pyramidal Tracts / Q000737:chemistry; D013788:Thalamus / Q000737:chemistry
chemical_list: D006993:Hypnotics and Sedatives; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate; D010424:Pentobarbital; D002794:Choline