Prognostic value of 1H-MRS in neonatal encephalopathy.

Full 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).

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Author information

Author/s: da Silva, Luis Fernando Garcias (LF); Höefel Filho, João Rubião (JR); Anés, Maurício (M); Nunes, Magda Lahorgue (ML);

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.

Journal and publication information

Publication Type: Clinical Trial; Journal Article

Journal: Pediatric neurology (Pediatr Neurol), published in United States. (Language: eng)

Reference: 2006-May; vol 34 (issue 5) : pp 360-6

Dates: Created 2006/05/01; Completed 2006/07/06;

PMID: 16647995, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Apgar Score
Aspartic Acid - analogs & derivatives; metabolism
Asphyxia Neonatorum - diagnosis; epidemiology; metabolism
Basal Ganglia - metabolism
Choline - metabolism
Creatine - metabolism
Creatinine - metabolism
Female
Follow-Up Studies
Humans
Hypoxia-Ischemia, Brain - diagnosis; epidemiology; metabolism
Infant, Newborn

Infant, Newborn
Lactic Acid - metabolism
Magnetic Resonance Spectroscopy
Male
Polysomnography
Predictive Value of Tests
Pregnancy
Pregnancy Complications - diagnosis; epidemiology; metabolism
Prognosis
Protons
Risk Factors
Thalamus - metabolism

Associated Chemicals: Protons (0) ; Lactic Acid (50-21-5) ; Aspartic Acid (56-84-8) ; Creatine (57-00-1) ; Creatinine (60-27-5) ; Choline (62-49-7) ; N-acetylaspartate (997-55-7)

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