DIAGNOSTIC AND PROGNOSTIC VALUE OF CEREBRAL P-31 MAGNETIC-RESONANCE SPECTROSCOPY IN NEONATES WITH PERINATAL ASPHYXIA

The impact of depressed neonatal cerebral oxidative phosphorylation fo r diagnosing the severity of perinatal asphyxia was estimated by corre lating the concentrations of phosphocreatine (PCr) and ATP as determin ed by magnetic resonance spectroscopy with the degree of hypoxic-ische mic encephalopathy (HIE) in 23 asphyxiated term neonates. Ten healthy age-matched neonates served as controls. In patients, the mean concent rations +/-SD of PCr and ATP were 0.99 +/- 0.46 mmol/L (1.6 +/- 0.2 mm ol/L) and 0.99 +/- 0.35 mmol/L (1.7 +/- 0.2 mmol/L), respectively (nor mal values in parentheses), [PCr] and [ATP] correlated significantly w ith the severity of HIE (r = 0.85 and 0.9, respec tively, p < 0.001), indicating that the neonatal encephalopathy is the clinical manifestat ion of a marred brain energy metabolism. Neurodevelopmental outcome wa s evaluated in 21 children at 3, 9, and 18 mo. Seven infants had multi ple impairments, five were moderately handicapped, five had only mild symptoms, and four were normal. There was a significant correlation be tween the cerebral concentrations of PCr or ATP at birth and outcome ( r = 0.8, p < 0.001) and between the degree of neonatal neurologic depr ession and outcome (r = 0.7). More important, the outcome of neonates with moderate HIE could better be predicted with information from quan titative P-31 magnetic resonance spectroscopy than from neurologic exa minations. In general, the accuracy of outcome predictability could si gnificantly be increased by adding results from P-31 magnetic resonanc e spectroscopy to the neonatal neurologic score, but not vice versa. N o correlation with outcome was found for other perinatal risk factors, including Apgar score.