Bevindingen bij cerebrale protonkernspinresonantie-spectroscopie bij pasgeborenen met asfyxie, en psychomotore ontwikkeling

To determine the relationship between the results of cerebral proton magnetic resonance spectroscopy (¹H-MRS) and neuromotor development in neonates with hypoxia.

Design

Descriptive.

Setting

Wilhelmina Childrens‘ Hospital and University Hospital, Utrecht, the Netherlands.

Method

32 infants with hypoxic-ischaemic encephalopathy (Sarnat grade I (mild; n = 5), grade II (moderate; 20), grade III (severe; 7)) were examined at a mean of 8 days following the hypoxic event (range 2-22). ¹H-MRS of the periventricular white matter and part of the basal ganglia was performed in a 1.5 T field; TRTE: 2000272 ms. Peak-to-peak NAACho ratios were calculated. The presence of a lactate resonance was considered abnormal. Assessment of neuromotor development of the survivors was performed at 6, 9 and 18 months of age.

Results

6 patients died (all grade III), 10 survived with handicaps (I grade III, 9 grade II). Handicaps consisted of spastic quadriplegia (n = 7), hemiplegia and mental retardation (n = 1), and global developmental delay (n = 2). The other 16 survivors were normal at 18 months. ¹H-MRS showed NAACho ratios of 0.97 (SD: 0.13) in the patients with a normal outcome and 0.74 (0.17) in the patients with an adverse outcome (handicaps or death); p < 0.0001 (t-test). Lactate was demonstrated in all 7 grade III neonates, but not in any of the other infants.

Conclusion

Cerebral ¹H-MRS was related to neurodevelopmental outcome of neonates with HIE. A low NAACho ratio and presence of a lactate resonance predicted an adverse outcome.