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Early proton magnetic resonance spectroscopy during and after therapeutic hypothermia in perinatal hypoxic–ischemic encephalopathy

Pediatric Radiology volume 49, pages 941–950 (2019)Cite this article

Abstract

Background

Hypoxic–ischemic encephalopathy (HIE) remains a significant cause of mortality and neurodevelopmental impairment despite treatment with therapeutic hypothermia. Magnetic resonance H1-spectroscopy measures concentrations of cerebral metabolites to detect derangements in aerobic metabolism.

Objective

We assessed MR spectroscopy in neonates with HIE within 18–24 h of initiating therapeutic hypothermia and at 5–6 days post therapeutic hypothermia.

Materials and methods

Eleven neonates with HIE underwent MR spectroscopy of the basal ganglia and white matter. We compared metabolite concentrations during therapeutic hypothermia and post-therapeutic hypothermia and between moderate and severe HIE.

Results

During therapeutic hypothermia, neonates with severe HIE had decreased basal ganglia N-acetylaspartate (NAA; 0.62±0.08 vs. 0.72±0.05; P=0.02), NAA + N-acetylaspartylglutamate (NAAG; 0.66±0.11 vs. 0.77±0.06; P=0.05), glycerophosphorylcholine + phosphatidylcholine (GPC+PCh; 0.28±0.05 vs. 0.38±0.06; P=0.02) and decreased white matter GPC+PCh (0.35±0.13 vs. 0.48±0.04; P=0.02) compared to neonates with moderate HIE. For all subjects, basal ganglia NAA decreased (−0.08±0.07; P=0.01), whereas white matter GPC+PCh increased (0.03±0.04; P=0.04) from therapeutic hypothermia MRI to post-therapeutic-hypothermia MRI. All metabolite values are expressed in mmol/L.

Conclusion

Decreased NAA and GPC+PCh were associated with greater HIE severity and could distinguish neonates who might benefit most from targeted additional neuroprotective therapies.

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Authors and Affiliations

  1. Fetal Medicine Institute, Children’s National Health System, 111 Michigan Ave. NW, Washington, DC, 20010, USA

    Ashley M. Lucke

  2. Department of Pediatrics (Neonatology), Baylor College of Medicine, Houston, TX, USA

    Ashley M. Lucke, Joseph L. Hagan, Allison Walton, Tiffany D. Stafford & Christopher J. Rhee

  3. Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children’s Hospital Pavilion for Women, Houston, TX, USA

    Anil N. Shetty & Magdalena Sanz Cortes

  4. Department of Radiology, Baylor College of Medicine, Houston, TX, USA

    Zili D. Chu

  5. Departments of Pediatrics (Neonatal-Perinatal Medicine) and Obstetrics and Gynecology, Penn State Health Children’s Hospital, Hershey, PA, USA

    Jeffrey R. Kaiser

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  1. Ashley M. Lucke
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Correspondence to Ashley M. Lucke.

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Conflicts of interest

This research was supported by the Evangelina Whitlock Foundation Grant for fellows in Neonatal-Perinatal Medicine at the Baylor College of Medicine. Dr. Lucke wrote the first draft of the manuscript. There was no honorarium, grant or other form of payment given to anyone to produce the manuscript.

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Lucke, A.M., Shetty, A.N., Hagan, J.L. et al. Early proton magnetic resonance spectroscopy during and after therapeutic hypothermia in perinatal hypoxic–ischemic encephalopathy. Pediatr Radiol 49, 941–950 (2019). https://doi.org/10.1007/s00247-019-04383-8

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  • DOI: https://doi.org/10.1007/s00247-019-04383-8

Keywords

  • Brain
  • Hypoxic–ischemic encephalopathy
  • Magnetic resonance imaging
  • Neonates
  • Spectroscopy