Use of brain lactate levels to predict outcome after perinatal asphyxia

Leth, Helle; Toft, P; Peitersen, Birgit; Lou, Hans Olav Christensen; Henriksen, O.

doi:10.1111/j.1651-2227.1996.tb14168.x

Cited by 50 publications

(32 citation statements)

References 30 publications

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“…Elevated Lac levels have been shown until months after the hypoxiaischemia, probably due to an influx of Lac-producing macrophages in the damaged tissue or an altered redox state (36,38,39). Lac/NAA was significantly elevated in the group with abnormal outcome, as in previous reports (1,6,32,40,41). Only three neonates were examined during the first day of life, so most of the Lac found is probably due to secondary energy failure and influx of macrophages (42).…”

Section: Discussionsupporting

confidence: 50%

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Value of 1H-MRS Using Different Echo Times in Neonates with Cerebral Hypoxia-Ischemia

2001

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Previous studies have shown altered brain metabolism after cerebral hypoxia-ischemia, using magnetic resonance spectroscopy with echo times (TE) of 272 and 136 ms, based on peak-area or peak-height ratios. The present study examined the additional value of proton magnetic resonance spectroscopy with a short TE (31 ms) to predict a poor outcome in neonates with brain hypoxia-ischemia. Studies were performed in 21 full-term neonates with perinatal asphyxia in a 1.5 tesla magnetic field. Proton magnetic resonance spectroscopy was performed in a single volume of interest including the basal ganglia. TE of 272, 136 and 31 ms were used. After curve-fitting procedures, peakareas as well as peak-height ratios of different brain metabolites were calculated, comparing patients with a poor versus a good outcome. Seven neonates out of 21 had a poor outcome. Neonates with a poor outcome showed a significantly lower Nacetylaspartate/choline (NAA/Cho) and a significantly raised lactate/NAA (Lac/NAA) ratio using TE of 272 and 136 ms. Using a TE of 31 ms, no differences were found in glutamate/ NAA (Glx/NAA), Glx/Cho, myo-inositol/NAA (mI/NAA), and mI/Cho ratios between neonates with a good and those with a poor outcome. Highest predictive values could be achieved for NAA/Cho with a TE of 136 ms. We conclude that low NAA/Cho and high Lac/NAA ratios predict a poor outcome in neonates with cerebral hypoxia-ischemia. Previous studies have shown changes in the cerebral metabolism of human neonates and of animals following hypoxiaischemia (1-5). Using 1 H-MRS, decreases in NAA/Cho and NAA/Cr ratios were noted to predict poor neurodevelopment (1). An increased brain Lac, which, under normal circumstances, is present in only very small amounts in the neonatal brain and is hardly detectable by 1 H-MRS at term age, also predicts a poor outcome (3, 6). These studies used TE of 272 or 136 ms (1, 2, 4, 6). Using a TE of 272 ms, the peak at 1.33 ppm represents Lac. Using a TE of 136 ms, the Lac peak will be inverted, thereby distinguishing between Lac and lipids or macromolecules. Due to coupling effects, the amplitude of the Lac peak is expected to be smaller at TE 136 ms compared with TE 272 ms (7). Secondly, T2 values for NAA, Cho, and Cr differ (8, 9), and thereby differences in NAA/Cho or NAA/Cr ratios between good outcome and poor outcome groups might be more prominent at certain TE. In addition, T2 values may change following cerebral hypoxia-ischemia (10). Therefore, differences in metabolite ratios might be more prominent at longer TE. In fact, a recent study demonstrated a better predictive value for a long TE (270 ms) versus a short TE (20 ms) in occipital gray matter of young children (11).With shorter TE, e.g. 30 ms, lipids and macromolecules can be identified. Especially in ischemic brain areas, these metabolites with resonances of 0.9 -1.3 ppm will be elevated massively, thereby complicating the detection of lactate at 1.33 ppm (12

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Section: Discussionsupporting

confidence: 50%

“…Using 1 H-MRS, decreases in NAA/Cho and NAA/Cr ratios were noted to predict poor neurodevelopment (1). An increased brain Lac, which, under normal circumstances, is present in only very small amounts in the neonatal brain and is hardly detectable by 1 H-MRS at term age, also predicts a poor outcome (3,6). These studies used TE of 272 or 136 ms (1,2,4,6).…”

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Value of 1H-MRS Using Different Echo Times in Neonates with Cerebral Hypoxia-Ischemia

2001

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“…Previously, many studies have demonstrated decreased NAA/Cho ratios and elevated lactate/NAA ratios in neonates with HIE and a poor neurodevelopmental outcome [7,11,[23][24][25][26]. In the present study, NAA/Cho was not decreased in neonates with severe HIE.…”

Section: Discussionsupporting

confidence: 52%

“…Using 1 H-MRS, decreases in N-acetylaspartate (NAA)/choline (Cho) (NAA/Cho) ratios have been shown to predict poor neurodevelopment [7] An increase in brain lactate, which under normal circumstances is present in only very small amounts in the neonatal brain and is hardly detectable by 1 H-MRS at term age, has also been found to predict a poor outcome [8,11]. These studies used TEs of 272 or 136 ms [7][8][9]11]. With shorter TEs, e.g.…”

Section: Introductionmentioning

confidence: 99%

Glutamate in Cerebral Tissue of Asphyxiated Neonates during the First Week of Life Demonstrated in vivo Using Proton Magnetic Resonance Spectroscopy

Groenendaal

Rijn²,

Toet³

et al. 2001

Neonatology

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We tested the hypothesis that glutamate (Glx) levels as demonstrated by proton magnetic resonance spectroscopy (¹H-MRS) are elevated in brain tissue of neonates with severe hypoxic-ischemic encephalopathy (HIE). Studies were performed in 26 neonates (median gestational age 40.5 weeks, range 36.7–42.4 weeks; median birth weight 3,360 g, range 2,180–4,200 g). The median postnatal age at the time of testing was 2.5 days (range 1–7 days). HIE was scored according to Sarnat as grade I (n = 4), grade II (n = 15) or grade III (n = 7). Results for neonates with mild to moderate HIE (group 1) were compared to those with severe HIE (group 2). After magnetic resonance imaging, ¹H-MRS was performed in a single volume of interest including the basal ganglia. An echo time of 31 ms was used. After curve-fitting procedures, peak area ratios of different brain metabolites were calculated. The median total Glx/N-acetylaspartate ratio was 1.21 (range 0.64–3.25) in group 1 versus 1.55 (range 1.10–2.75) in group 2 (p = 0.035). The median total Glx/choline ratio was 1.33 (range 0.71–2.52) in group 1 versus 2.14 (range 1.21–3.55) in group 2 (p = 0.019). We concluded that during the first days of life, Glx was elevated in the basal ganglia of neonates with severe HIE.

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“…[1][2][3][4][5][6][7][8][9][10][11][12] Elevated brain metabolite ratios, lactate/Nacetylaspartate (NAA) and lactate/choline, have been associated with poor neurodevelopmental status in neonates with hypoxic-ischemic encephalopathy. 1,10,12,13 The increase in brain lactate level is thought to be a result of anaerobic rather than oxidative energy metabolism during cellular hypoxia.…”

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confidence: 99%

Brain Metabolite Levels Assessed by Lactate-Edited MR Spectroscopy in Premature Neonates with and without Pentobarbital Sedation

Wang¹,

Vigneron²,

Miller³

et al. 2008

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Pentobarbital is known to affect cerebral metabolism; pentobarbital sedation is, however, frequently used for MR imaging and MR spectroscopy, especially in children. Accurate assessment of the brain metabolite levels is important, particularly in neonates with suspected brain injury. We investigated whether pentobarbital sedation has any effect on the ratios of spectral metabolites lactate, N-acetylaspartate, or choline in a group of premature neonates.

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Use of brain lactate levels to predict outcome after perinatal asphyxia

Cited by 50 publications

References 30 publications

Value of 1H-MRS Using Different Echo Times in Neonates with Cerebral Hypoxia-Ischemia

Value of 1H-MRS Using Different Echo Times in Neonates with Cerebral Hypoxia-Ischemia

Glutamate in Cerebral Tissue of Asphyxiated Neonates during the First Week of Life Demonstrated in vivo Using Proton Magnetic Resonance Spectroscopy

Brain Metabolite Levels Assessed by Lactate-Edited MR Spectroscopy in Premature Neonates with and without Pentobarbital Sedation

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