RELATION OF DERANGED NEONATAL CEREBRAL OXIDATIVE-METABOLISM WITH NEURODEVELOPMENTAL OUTCOME AND HEAD CIRCUMFERENCE AT 4 YEARS

Cerebral oxidative metabolism was studied using phosphorus magnetic re sonance spectroscopy during the first week of Life and neurodevelopmen tal outcome was assessed at 4 years in 62 infants who had clinical and /or biochemical evidence consistent with birth asphyxia (critically im paired intrapartum gas exchange). Twenty-one died and the neurodevelop mental status of the 41 who survived was assessed by a range of tests at age 4 years. The minimum recorded values for the cerebral phosphocr eatine:inorganic phosphate concentration ratio (an index of oxidative metabolism) were related to outcome. The results showed significant re lations between the extent of derangement of neonatal oxidative metabo lism and a range of adverse outcomes, including death, and at 4 years reduced head growth and the presence and severity of neuromotor impair ments, overall neurodevelopmental impairments, and cognitive functioni ng. Strong correlations between the extent of derangement of neonatal oxidative metabolism and outcome at 1 and 4 years were also shown. We conclude that the severities of adverse outcomes at 1 and 4 years of a ge were closely related to the extent of cerebral energy derangement i n the first week of life, and we also conclude that primary intrapartu m hypoxic-ischaemic cerebral injury was generally responsible for the events that led to death, microcephaly, and impaired (sic).