Division of Neonatology, 1st Department of Paediatrics, Semmelweis University, Budapest, Hungary.
Medical Imaging Centre, Department of Neuroradiology, Semmelweis University, Budapest, Hungary.
Pediatr Res. 2022 Feb;91(3):581-589. doi: 10.1038/s41390-021-01626-z. Epub 2021 Sep 6.
Prognostic value of proton MR spectroscopy (H-MRS) in hypoxic-ischemic encephalopathy (HIE) is acknowledged; however, effects of gestational age (GA) and postnatal age (PA) on prediction and metabolite levels are unknown.
One hundred and sixty-nine newborns with moderate-to-severe HIE were studied, having ≥1 H-MRS scan during postnatal days 0-14 and known neurodevelopmental outcome (Bayley-II score/cerebral palsy/death). Initial scans were categorized by PA (day 1-3/4-6/≥7), and metabolite ratios were compared by predictive value. Metabolite dynamics were assessed in a total of 214 scans performed in the study population, using regression modeling, with predictors GA, PA, and outcome.
N-acetyl-aspartate (NAA)/creatine (Cr) and myo-inositol (mI)/NAA height ratios were consistently associated with outcome throughout the first 14 days, with the highest predictive value in the late (≥7 days) period (AUC = 0.963 and 0.816, respectively). Neither GA nor PA had an overall effect on these metabolite ratios, which showed strongest association with outcome (p < 0.001). Assessed separately in patients with good outcome, GA became a significant covariate for metabolite ratios (p = 0.0058 and 0.0002, respectively). However, this association disappeared in the poor outcome group.
In HIE, NAA/Cr and mI/NAA give most accurate outcome prediction throughout postnatal days 0-14. GA only affected metabolite levels in the good outcome group.
Proton MR spectroscopy metabolite ratios N-acetyl-aspartate/creatine and myo-inositol/N-acetyl-aspartate have persistently high predictive value throughout postnatal days 0-14 in newborns with hypoxic-ischemic encephalopathy, with the highest predictive power between postnatal days 7 and 14. Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome. However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared. Proton MR spectroscopy provides valuable prognostic information in neonatal hypoxic-ischemic encephalopathy throughout the first 2 weeks of life, irrespective of the timing of MR scan.
质子磁共振波谱（H-MRS）在缺氧缺血性脑病（HIE）中的预后价值已得到认可；然而，目前尚不清楚胎龄（GA）和生后年龄（PA）对预测和代谢物水平的影响。
研究了 169 例中重度 HIE 新生儿，在生后 0-14 天内进行了至少 1 次 H-MRS 扫描，并具有已知的神经发育结局（贝利 II 评分/脑瘫/死亡）。初始扫描按 PA（第 1-3/4-6/≥7 天）分类，并比较预测值的代谢物比值。使用回归模型，通过 GA、PA 和结局作为预测因子，对研究人群中的 214 次扫描进行代谢物动态评估。
N-乙酰天冬氨酸（NAA）/肌酸（Cr）和肌醇（mI）/NAA 高度比在整个前 14 天内与结局始终相关，在晚期（≥7 天）具有最高的预测价值（AUC 分别为 0.963 和 0.816）。GA 和 PA 均未对这些代谢物比值产生总体影响，它们与结局的相关性最强（p<0.001）。在结局良好的患者中分别评估时，GA 成为代谢物比值的显著协变量（p=0.0058 和 0.0002）。然而，在结局不良的组中，这种关联消失了。
在 HIE 中，NAA/Cr 和 mI/NAA 在生后 0-14 天内提供最准确的结局预测。GA 仅影响结局良好组的代谢物水平。
质子磁共振波谱代谢物比值 N-乙酰天冬氨酸/肌酸和肌醇/N-乙酰天冬氨酸在缺氧缺血性脑病新生儿中具有持续高的预测价值，在生后 7-14 天之间具有最高的预测能力。总体而言，代谢物比值不受胎龄和生后年龄的影响，而与神经结局的相关性最强。然而，在结局良好的新生儿中，代谢物比值与胎龄相关，而在结局不良的情况下，这种关联消失了。质子磁共振波谱在新生儿缺氧缺血性脑病的前 2 周内提供了有价值的预后信息，而与磁共振扫描的时间无关。
