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Early brain proton magnetic resonance spectroscopy and neonatal neurology related to neurodevelopmental outcome at 1 year in term infants after presumed hypoxic–ischaemic brain injury

Published online by Cambridge University Press:  01 July 1999

P N Amess ,
Juliet Penrice ,
Marzena Wylezinska ,
Ann Lorek ,
Janice Townsend ,
J S Wyatt ,
Claudine Amiel-Tison ,
E B Cady  and
Ann Stewart
P N Amess
Affiliation:
Department of Paediatrics, University College London Medical School, London, UK.
Juliet Penrice
Affiliation:
Department of Paediatrics, University College London Medical School, London, UK.
Marzena Wylezinska
Affiliation:
Department of Medical Physics and Bioengineering, University College London Hospitals NHS Trust , London, UK.
Ann Lorek
Affiliation:
Department of Paediatrics, University College London Medical School, London, UK.
Janice Townsend
Affiliation:
Department of Paediatrics, University College London Medical School, London, UK.
J S Wyatt
Affiliation:
Department of Paediatrics, University College London Medical School, London, UK.
Claudine Amiel-Tison
Affiliation:
Department of Paediatrics, Port-Royal-Baudeloque, Paris, France.
E B Cady
Affiliation:
Department of Medical Physics and Bioengineering, University College London Hospitals NHS Trust , London, UK.
Ann Stewart
Affiliation:
Department of Paediatrics, University College London Medical School, London, UK.
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Abstract

This study investigated the accuracy of prediction of neurodevelopmental outcome at 1 year using cerebral proton magnetic resonance spectroscopy (MRS) and structured neonatal neurological assessment in term infants after presumed hypoxic–ischaemic brain injury. Eighteen control infants and 28 infants with presumed hypoxic–ischaemic brain injury underwent proton MRS investigation. Studies were carried out as soon as possible after the cerebral insult, most within 48 hours. Infants had an early structured neurological assessment at a median of 19 hours (range 0 hours to 9 days) from the presumed hypoxic–ischaemic insult and a late assessment at a median of 7 days (range 3 to 25 days) during recovery. The maximum cerebral peak–area ratio lactate:N-acetylaspartate measured by proton MRS accurately predicted adverse outcome at 1 year with a specificity of 93% and positive predictive value of 92%. Neurological assessment had a tendency for false-positive predictions. However, both early and late neurological examination can be used as a reliable indicator for a favourable outcome at 1 year having negative predictive values of 100% and 91% respectively.

Type
Original Articles
Information
Developmental Medicine and Child Neurology , Volume 41 , Issue 7 , July 1999 , pp. 436 - 445
Copyright
© 1999 Mac Keith Press

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