Ahearne C E, Denihan N M, Walsh B H, Reinke S N, Kenny L C, Boylan G B, Broadhurst D I, Murray D M
The Irish Centre for Fetal and Neonatal Translational Research (INFANT), Cork, Ireland.
Neonatology. 2016;110(4):296-302. doi: 10.1159/000446556. Epub 2016 Aug 3.
A 1H-NMR-derived metabolomic index based on early umbilical cord blood alterations of succinate, glycerol, 3-hydroxybutyrate and O-phosphocholine has shown potential for the prediction of hypoxic-ischaemic encephalopathy (HIE) severity.
To evaluate whether this metabolite score can predict 3-year neurodevelopmental outcome in infants with perinatal asphyxia and HIE, compared with current standard biochemical and clinical markers.
From September 2009 to June 2011, infants at risk of perinatal asphyxia were recruited from a single maternity hospital. Cord blood was drawn and biobanked at delivery. Neonates were monitored for development of encephalopathy both clinically and electrographically. Neurodevelopmental outcome was assessed at 36-42 months using the Bayley Scales of Infant and Toddler Development, ed. III (BSID-III). Death and cerebral palsy were also considered as abnormal end points.
Thirty-one infants had both metabolomic analysis and neurodevelopmental outcome at 36-42 months. No child had a severely abnormal BSID-III result. The metabolite index significantly correlated with outcome (ρ2 = 0.30, p < 0.01), which is robust to predict both severe outcome (area under the receiver operating characteristic curve: 0.92, p < 0.01) and intact survival (0.80, p = 0.01). There was no correlation between the index score and performance in the individual BSID-III subscales (cognitive, language, motor).
The metabolite index outperformed other standard biochemical markers at birth for prediction of outcome at 3 years, but was not superior to EEG or the Sarnat score.
基于脐血中琥珀酸、甘油、3-羟基丁酸和O-磷酸胆碱早期变化的1H-NMR代谢组学指标已显示出预测缺氧缺血性脑病（HIE）严重程度的潜力。
与当前标准生化和临床指标相比，评估该代谢物评分能否预测围产期窒息和HIE婴儿3岁时的神经发育结局。
2009年9月至2011年6月，从一家妇产医院招募有围产期窒息风险的婴儿。分娩时采集脐血并进行生物样本库储存。对新生儿进行临床和脑电图监测以观察脑病的发展情况。在36 - 42个月时使用贝利婴幼儿发育量表第三版（BSID-III）评估神经发育结局。死亡和脑瘫也被视为异常终点。
31名婴儿在36 - 42个月时进行了代谢组学分析和神经发育结局评估。没有儿童的BSID-III结果严重异常。代谢物指数与结局显著相关（ρ2 = 0.30，p < 0.01），在预测严重结局（受试者操作特征曲线下面积：0.92，p < 0.01）和完整存活（0.80，p = 0.01）方面都很可靠。指数评分与BSID-III各个子量表（认知、语言、运动）的表现之间没有相关性。
代谢物指数在预测3岁结局方面优于出生时的其他标准生化指标，但并不优于脑电图或萨纳特评分。
