Cerebral lactate and N-acetyl-aspartate/choline ratios in asphyxiated full-term neonates demonstrated in vivo using proton magnetic resonance spectroscopy

• Published in: Pediatric research Vol. 35; no. 2; pp. 148 - 151
• Main Authors: GROENENDAAL, F, VEENHOVEN, R. H, VAN DER GROND, J, JANSEN, G. H, WITKAMP, T. D, DE VRIES, L. S
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.1994
• Subjects: Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Asphyxia Neonatorum - metabolism; Asphyxia Neonatorum - pathology; Biological and medical sciences; Brain - metabolism; Choline - metabolism; Delivery. Postpartum. Lactation; Gynecology. Andrology. Obstetrics; Humans; Infant; Infant, Newborn; Lactates - metabolism; Lactic Acid; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Medical sciences; Nervous System - growth & development; Nervous System - pathology; Obstetrical techniques; Prognosis; Human; Nervous system diseases; Neonatal; Prognosis; Biological marker; Aspartate; NMR spectrometry; Asphyxia; Nuclear magnetic resonance imaging; Cerebral disorder; In vivo; Newborn; Choline; Encephalopathy; Central nervous system disease; Proton; Hypoxia; Lactic acid; Quantitative analysis; Brain (vertebrata)
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1203/00006450-199402000-00004

The purpose of this study was to test the hypothesis that a high lactate signal and a low N-acetyl-aspartate/choline ratio in neonates with postasphyxial encephalopathy indicated a high chance of an adverse outcome in vivo when proton magnetic resonance spectroscopy was used. Twenty-one full-term asphyxiated neonates were examined at a mean postnatal age of 7.1 d. Five patients died, and five survivors had handicaps. Eleven of the 16 survivors (seven without handicaps and four with handicaps) had a second examination at 3 mo of age. After magnetic resonance imaging, spectra were obtained at 1.5 tesla. A 20-mm-thick slice was selected through the basal ganglia. After optimizing the B-0 field, we used a double spin-echo pulse sequence (90-180-180 degrees) with a time to repeat of 2000 ms and a time to echo of 272 ms. Two-dimensional spectroscopic imaging was performed by 32 x 32 phase encoding steps in two directions in a 225-mm field of view, resulting in 1-mL volumes, followed by computerized processing. Neuromotor development was examined at 6 wk, 3 mo, and every 3 mo thereafter. Lactate resonances were seen only in the five patients with grade 3 postasphyxial encephalopathy. Lactate was distributed diffusely (n = 4), or localized in areas of infarction (n = 1). N-acetyl-aspartate/choline ratios were significantly lower in the patients with an adverse outcome than in the survivors without handicaps, both neonatally (p < 0.005, Wilcoxon's rank sum test) and at 3 mo (p < 0.05).