USE OF BRAIN LACTATE LEVELS TO PREDICT OUTCOME AFTER PERINATAL ASPHYXIA

Perinatal asphyxia is an important cause of neurological disability, b ut early prediction of outcome can be difficult. We performed proton m agnetic resonance spectroscopy (MRS) and global cerebral blood flow me asurements by xenon-133 clearance in 16 infants with evidence of perin atal asphyxia. Cerebral blood flow was determined daily in the first 3 days after birth in seven cases. Proton MRS was performed in 11 infan ts within the first week (mean 3.7 days), the rest within the first mo nth (mean 22.2 days), and all had a scan around 3 months of age. Four infants died neonatally, three showed neurological deficits and the re st seemed to be progressing normally at neurodevelopmental followup at 1 year of age. A significant correlation was found between initial br ain lactate levels and severe outcome (p = 0.0003) lust as between cer ebral hyperperfusion (mean cerebral blood Row (CRF) 86 ml (100 g)(-1) min(-1)), (p = 0.02) and outcome. The diagnostic and prognostic implic ations of early MRS and CBF are predictive of poor outcome in severely asphyxiated infants.