title: Low plasma magnesium is associated with impaired brain metabolism in neonates with hypoxic-ischaemic encephalopathy.
abstract: OBJECTIVE
  To determine the association between lowest plasma magnesium concentration and brain metabolism, and whether magnetic resonance imaging brain injury patterns moderated the association in hypoxic-ischemic encephalopathy.
  
  
  METHODS
  In 131 early (day-of-life 3) and 65 late (day-of-life 10) scans of term encephalopathic infants born between 2004 and 2012, we examined the association of lowest plasma magnesium (until day-of-life 3) on basal ganglia and white matter peak metabolite ratios on magnetic resonance spectroscopy independent of covariates, stratified by the predominant patterns of injury (normal, basal nuclei/total, watershed, multifocal) using multiple linear regression.
  
  
  RESULTS
  Lowest plasma magnesium was associated with lower white matter N-acetyl-aspartate/choline in the multifocal pattern on early scan (regression-coefficient, β: 0.13; 95% CI: 0.04, 0.22) and in the basal nuclei/total pattern on late scan (β: 0.08; 95% CI: 0.02, 0.15), and was negatively associated with basal ganglia lactate/N-acetyl-aspartate (β: -0.16; 95% CI: -0.05, -0.28) and lactate/choline (β: -0.1; 95% CI: -0.03, -0.17) ratio in the basal nuclei/total pattern on late scan independent of hypomagnesaemia correction, cooling and postmenstrual age at scan. Lowest plasma magnesium was not associated with metabolite ratios in other brain injury patterns.
  
  
  CONCLUSIONS
  In infants with hypoxic-ischaemic encephalopathy, predominant patterns of brain injury moderated the association between lowest plasma magnesium in the first three days of life and impaired brain metabolism.
authors.affiliation: Department of Pediatrics, University of British Columbia and Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.|School of Clinical Sciences, St Michael's Hospital, University of Bristol, Bristol, UK.
authors.forename: Elavazhagan
authors.initials: E
authors.lastname: Chakkarapani
authors.affiliation: Child and Family Research Institute, Vancouver, BC, Canada.|Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Vann
authors.initials: V
authors.lastname: Chau
authors.affiliation: Department of Pediatrics, University of British Columbia and Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.|Child and Family Research Institute, Vancouver, BC, Canada.|Department of Radiology, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Poskitt
authors.affiliation: Department of Pediatrics, University of British Columbia and Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.|Child and Family Research Institute, Vancouver, BC, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Synnes
authors.affiliation: Department of Pediatrics, University of British Columbia and Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.
authors.forename: Eddie
authors.initials: E
authors.lastname: Kwan
authors.affiliation: Department of Pediatrics, University of British Columbia and Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.
authors.forename: Elke
authors.initials: E
authors.lastname: Roland
authors.affiliation: Department of Pediatrics, University of British Columbia and Children's & Women's Health Centre of British Columbia, Vancouver, BC, Canada.|Child and Family Research Institute, Vancouver, BC, Canada.|Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Miller
mesh_terms: D001921:Brain / Q000378:metabolism*; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000378:metabolism*; D007231:Infant, Newborn; D008274:Magnesium / Q000097:blood*; D008297:Male; D012189:Retrospective Studies
chemical_list: D008274:Magnesium
keywords: Brain metabolism; Hypoxic-ischaemic encephalopathy; Magnetic resonance spectroscopy; Newborn; Plasma magnesium