title: Clinical Factors Associated with Cerebral Metabolism in Term Neonates with Congenital Heart Disease.
abstract: To determine associations between patient and clinical factors with postnatal brain metabolism in term neonates with congenital heart disease (CHD) via the use of quantitative magnetic resonance spectroscopy.
  
  
  
  Neonates with CHD were enrolled prospectively to undergo pre- and postoperative 3T brain magnetic resonance imaging. Short-echo single-voxel magnetic resonance spectroscopy of parietal white matter was used to quantify metabolites related to brain maturation (n-acetyl aspartate, choline, myo- inositol), neurotransmitters (glutamate and gamma-aminobutyric acid), energy metabolism (glutamine, citrate, glucose, and phosphocreatine), and injury/apoptosis (lactate and lipids). Multivariable regression was performed to search for associations between (1) patient-specific/prenatal/preoperative factors with concurrent brain metabolism and (2) intraoperative and postoperative factors with postoperative brain metabolism.
  
  
  
  A total of 83 magnetic resonance images were obtained on 55 subjects. No patient-specific, prenatal, or preoperative factors associated with concurrent metabolic brain dysmaturation or elevated lactate could be identified. Chromosome 22q11 microdeletion and age at surgery were predictive of altered concurrent white matter phosphocreatine (P < .0055). The only significant intraoperative association found was increased deep hypothermic circulatory arrest time with reduced postoperative white matter glutamate and gamma-aminobutyric acid (P < .0072). Multiple postoperative factors, including increased number of extracorporeal membrane oxygenation days (P < .0067), intensive care unit, length of stay (P < .0047), seizures in the intensive care unit (P < .0009), and home antiepileptic use (P < .0002), were associated with reduced postoperative white matter n-acetyl aspartate.
  
  
  
  Multiple postoperative factors were found to be associated with altered brain metabolism in term infants with CHD, but not patient-specific, preoperative, or intraoperative factors.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA.
authors.forename: Anna Lonyai
authors.initials: AL
authors.lastname: Harbison
authors.affiliation: Division of Cardiology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA.
authors.forename: Jodie K
authors.initials: JK
authors.lastname: Votava-Smith
authors.affiliation: Department of Anesthesiology, Critical Care Medicine, Children's Hospital of Los Angeles, Los Angeles, CA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Del Castillo
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Children's Hospital of Los Angeles/University of Southern California, Los Angeles, CA.
authors.forename: S Ram
authors.initials: SR
authors.lastname: Kumar
authors.affiliation: Department of Pediatric Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Vince
authors.initials: V
authors.lastname: Lee
authors.affiliation: Department of Pediatric Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Schmithorst
authors.affiliation: Division of Radiology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA.
authors.forename: Hollie A
authors.initials: HA
authors.lastname: Lai
authors.affiliation: Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA.
authors.forename: Sharon
authors.initials: S
authors.lastname: O'Neil
authors.affiliation: Division of Radiology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Bluml
authors.affiliation: Division of Neonatology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Paquette
authors.affiliation: Department of Pediatric Radiology, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: panigrahya@upmc.edu.
authors.forename: Ashok
authors.initials: A
authors.lastname: Panigrahy
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D001724:Birth Weight; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D005973:Glutamine / Q000378:metabolism; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D019344:Lactic Acid / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D015999:Multivariate Analysis; D010725:Phosphocreatine / Q000378:metabolism; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D015996:Survival Rate; D047929:Term Birth; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010725:Phosphocreatine; D005973:Glutamine; D001224:Aspartic Acid; D019344:Lactic Acid; C000179:N-acetylaspartate
keywords: brain dysmaturation; lactate; phosphocreatine; punctate white matter injury