The prognostic value of proton magnetic resonance spectroscopy in term newborns treated with therapeutic hypothermia following asphyxia

Publication date: Available online 12 June 2017
Source:Magnetic Resonance Imaging
Author(s): Paul E. Sijens, Katharina Wischniowsky, Hendrik J. ter Horst
ObjectiveThe purpose of this study was to correlate brain metabolism assessed shortly after therapeutic hyperthermia by ¹H magnetic resonance spectroscopy (MRS), with neurodevelopmental outcome.MethodsAt the age of 6.0±1.8days, brain metabolites of 35 term asphyxiated newborns, treated with therapeutic hypothermia, were quantified by multivoxel proton MRS of a volume cranial to the corpus callosum, containing both gray and white matter. At the age of 30months the Bayley Scale of Infant Development-III was performed.ResultsInfants that died had lower gray matter NAA levels than infants that survived (P=0.005). In surviving infants (28 of 35) there was a trend of negative correlation between gray matter choline levels and gross motor outcome (r=−0.45). In the white matter, choline correlated negatively with fine motor skills (r=−0.40), and creatine positively with gross motor skills (r=0.58, P=0.02). There was no relationship between lactate levels and outcome.ConclusionMRS of asphyxiated neonates treated by therapeutic hypothermia can serve as predictor of outcome. Unlike previously reported associations in untreated asphyxiates, lactate levels had no relationship with outcome, which indicates that one of the working mechanisms of therapeutic hypothermia is reduction of the metabolic rate.



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