Zasada Magdalena, Olszewska Marta, Kowalik Aleksandra, Berska Joanna, Bugajska Jolanta, Karcz Paulina, Herman-Sucharska Izabela, Kwinta Przemko
Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
Department of Clinical Biochemistry, University Children's Hospital, Krakow, Poland.
Neonatology. 2025;122(2):222-231. doi: 10.1159/000542793. Epub 2024 Dec 10.
This study aimed to assess the association between the urinary lactate-to-creatinine ratio (ULCR) and brain spectroscopy (1H-MRS) findings in very low gestational age (VLGA) infants with and without preterm brain injury.
Urine samples were collected from 54 VLGA infants during the first week of life, after 1 month of life, and at term-equivalent age (TEA). Urinary lactate was measured via highly selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) with a quantitative organic acid analysis kit and expressed as the ULCR. Magnetic resonance imaging and 1H-MRS were performed at TEA. The Kidokoro grading system was used to assess the Global Brain Abnormality Score (GBAS).
VLGA infants with a GBAS moderate + severe had higher ULCRs on the 2nd and 3rd days of life (DOLs) than those with a GBAS normal or mild. Only the GBAS moderate + severe subgroup presented with a secondary increase in the ULCR on the 3rd DOL, whereas in the GBAS normal or mild, the ULCR oscillated around similar values or gradually decreased. Significant positive correlations were detected between the ULCR on the 3rd DOL and the lactate/creatinine and lactate/N-acetyl aspartate ratios measured via 1H-MRS at TEA (r = 0.308; p = 0.022 and r = 0.334; p = 0.013, respectively).
An increased ULCR during the first 3 DOLs in patients with a GBAS moderate + severe suggest an energy catastrophe that may play a role in the development of premature brain injury. Serial measurement of the ULCR during the first DOLs may help in the early identification of premature infants at risk for moderate + severe brain damage.
This study aimed to assess the association between the urinary lactate-to-creatinine ratio (ULCR) and brain spectroscopy (1H-MRS) findings in very low gestational age (VLGA) infants with and without preterm brain injury.
Urine samples were collected from 54 VLGA infants during the first week of life, after 1 month of life, and at term-equivalent age (TEA). Urinary lactate was measured via highly selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) with a quantitative organic acid analysis kit and expressed as the ULCR. Magnetic resonance imaging and 1H-MRS were performed at TEA. The Kidokoro grading system was used to assess the Global Brain Abnormality Score (GBAS).
VLGA infants with a GBAS moderate + severe had higher ULCRs on the 2nd and 3rd days of life (DOLs) than those with a GBAS normal or mild. Only the GBAS moderate + severe subgroup presented with a secondary increase in the ULCR on the 3rd DOL, whereas in the GBAS normal or mild, the ULCR oscillated around similar values or gradually decreased. Significant positive correlations were detected between the ULCR on the 3rd DOL and the lactate/creatinine and lactate/N-acetyl aspartate ratios measured via 1H-MRS at TEA (r = 0.308; p = 0.022 and r = 0.334; p = 0.013, respectively).
An increased ULCR during the first 3 DOLs in patients with a GBAS moderate + severe suggest an energy catastrophe that may play a role in the development of premature brain injury. Serial measurement of the ULCR during the first DOLs may help in the early identification of premature infants at risk for moderate + severe brain damage.
本研究旨在评估极低胎龄（VLGA）有无早产脑损伤婴儿的尿乳酸与肌酐比值（ULCR）和脑波谱（1H-MRS）结果之间的关联。
收集了54例VLGA婴儿出生后第一周、出生1个月后及足月矫正年龄（TEA）时的尿液样本。采用高选择性液相色谱-串联质谱法（LC-MS/MS）和定量有机酸分析试剂盒测定尿乳酸，并以ULCR表示。在TEA时进行磁共振成像和1H-MRS检查。采用Kidokoro分级系统评估全脑异常评分（GBAS）。
GBAS为中度+重度的VLGA婴儿在出生后第2天和第3天的ULCR高于GBAS正常或轻度的婴儿。仅GBAS中度+重度亚组在出生后第3天ULCR出现二次升高，而GBAS正常或轻度组中，ULCR在相似值附近波动或逐渐下降。在出生后第3天的ULCR与TEA时通过1H-MRS测得的乳酸/肌酐和乳酸/N-乙酰天门冬氨酸比值之间检测到显著正相关（r = 0.308；p = 0.022和r = 0.334；p = 0.013）。
GBAS为中度+重度的患者在出生后前3天ULCR升高提示能量灾难，这可能在早产脑损伤的发生中起作用。在出生后第1天进行ULCR的系列测量可能有助于早期识别有中度+重度脑损伤风险的早产儿。
本研究旨在评估极低胎龄（VLGA）有无早产脑损伤婴儿的尿乳酸与肌酐比值（ULCR）和脑波谱（1H-MRS）结果之间的关联。
收集了54例VLGA婴儿出生后第一周、出生1个月后及足月矫正年龄（TEA）时的尿液样本。采用高选择性液相色谱-串联质谱法（LC-MS/MS）和定量有机酸分析试剂盒测定尿乳酸，并以ULCR表示。在TEA时进行磁共振成像和1H-MRS检查。采用Kidokoro分级系统评估全脑异常评分（GBAS）。
GBAS为中度+重度的VLGA婴儿在出生后第2天和第3天的ULCR高于GBAS正常或轻度的婴儿。仅GBAS中度+重度亚组在出生后第3天ULCR出现二次升高，而GBAS正常或轻度组中，ULCR在相似值附近波动或逐渐下降。在出生后第3天的ULCR与TEA时通过1H-MRS测得的乳酸/肌酐和乳酸/N-乙酰天门冬氨酸比值之间检测到显著正相关（r = 0.308；p = 0.022和r = 0.334；p = 0.013）。
GBAS为中度+重度的患者在出生后前3天ULCR升高提示能量灾难，这可能在早产脑损伤的发生中起作用。在出生后第1天进行ULCR的系列测量可能有助于早期识别有中度+重度脑损伤风险的早产儿。
