Early increases in brain myo-inositol measured by proton magnetic resonance spectroscopy in term infants with neonatal encephalopathy

Our aim was to assess brain myo-inositol/creatine plus phosphocreatine (Cr) in the first week in term infants with neonatal encephalopathy using local ized short echo time proton magnetic resonance spectroscopy and to relate t his to measures of brain injury, specifically lactate/Cr in the first week, basal ganglia changes on magnetic resonance imaging (MRI), and neurodevelo pmental outcome at 1 y. Fourteen term infants with neonatal encephalopathy of gestational age (mean +/- SD) 39.6 +/- 1.6 wk, birth weight 3270 +/- 490 g, underwent MRI and magnetic resonance spectroscopy at 3.5 +/- 2.1 d. Fiv e infants were entered in a pilot study of treatment with moderate whole-bo dy hypothermia for neonatal encephalopathy; two were being cooled at the ti me of the scan. T1- and T(2-)weighted transverse magnetic resonance images were graded as normal or abnormal according to the presence or absence of t he normal signal intensity of the posterior limb of the internal capsule an d signal intensity changes in the basal ganglia. Localized proton magnetic resonance spectroscopy data were obtained from an 8-cm(3) voxel in the basa l ganglia using echo times of 40 and 270 ms, and the peak area ratios of my o-inositol/Cr and lactate/Cr were measured. Outcome was scored using Griffi th's development scales and neurodevelopmental examination at I y MRI and o utcome were normal in six infants and abnormal in eight. myo-inositol/Cr an d lactate/Cr were higher in infants with abnormal MRI and outcome (p < 0.01 , p < 0.01, respectively). myo-Inositol/Cr and lactate/Cr were correlated ( p < 0.01) and were both correlated to the Griffith's developmental scales ( p < 0.01, p < 0.01, respectively). In conclusion, these preliminary data su ggest that early increases in brain basal ganglia myo-inositol/Cr in infant s with neonatal encephalopathy are associated with increased lactate/Cr, MR I changes of severe injury, and a poor neurodevelopmental outcome at 1 y.