BACKGROUND Although thalamic magnetic resonance (MR) spectroscopy (MRS) accurately predicts adverse outcomes after neonatal encephalopathy, its utility in infants without MR visible deep brain nuclei injury is not known. We examined thalamic MRS metabolite perturbations in encephalopathic infants with white matter (WM) injury with or without cortical injury and its associations with adverse outcomes. METHODS We performed a subgroup analysis of all infants recruited to the MARBLE study with isolated WM or mixed WM/cortical injury, but no visible injury to the basal ganglia/thalamus (BGT) or posterior limb of the internal capsule (PLIC). We used binary logistic regression to examine the association of MRS biomarkers with three outcomes (i) WM injury score (1 vs. 2/3); (ii) cortical injury scores (0/1 vs. 2/3); and (iii) adverse outcomes (defined as death, moderate/severe disability) at two years (yes/no). We also assessed the accuracy of MRS for predicting adverse outcome. FINDINGS Of the 107 infants included in the analysis, five had adverse outcome. Reduced thalamic N-acetylaspartate concentration [NAA] (odds ratio 0.4 (95% CI 0.18-0.93)) and elevated thalamic Lactate/NAA peak area ratio (odds ratio 3.37 (95% CI 1.45-7.82)) were significantly associated with higher WM injury scores, but not with cortical injury. Thalamic [NAA] (≤5.6 mmol/kg/wet weight) had the best accuracy for predicting adverse outcomes (sensitivity 1.00 (95% CI 0.16-1.00); specificity 0.95 (95% CI 0.84-0.99)). INTERPRETATION Thalamic NAA is reduced in encephalopathic infants without MR visible deep brain nuclei injury and may be a useful predictor of adverse outcomes. FUNDING The National Institute for Health Research (NIHR).

中文翻译：

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新生儿脑病后的白质损伤与丘脑代谢紊乱有关。


背景虽然丘脑磁共振（MR）波谱（MRS）可以准确预测新生儿脑病后的不良后果，但其在没有 MR 可见深部脑核损伤的婴儿中的效用尚不清楚。我们检查了伴有或不伴有皮质损伤的白质（WM）损伤的脑病婴儿的丘脑 MRS 代谢物扰动及其与不良后果的关系。方法 我们对参加 MARBLE 研究的所有婴儿进行了亚组分析，这些婴儿患有孤立性 WM 或混合性 WM/皮质损伤，但基底神经节/丘脑 (BGT) 或内囊后肢 (PLIC) 没有明显损伤。我们使用二元逻辑回归来检查 MRS 生物标志物与三个结果的关联：(i) WM 损伤评分（1 与 2/3）； (ii) 皮质损伤评分（0/1 vs. 2/3）； (iii) 两年内的不良后果（定义为死亡、中度/重度残疾）（是/否）。我们还评估了 MRS 预测不良结果的准确性。结果 在分析中纳入的 107 名婴儿中，有 5 名出现不良后果。丘脑 N-乙酰天冬氨酸浓度 [NAA] 降低（比值比 0.4 (95% CI 0.18-0.93)）和丘脑乳酸/NAA 峰面积比升高（比值比 3.37 (95% CI 1.45-7.82)）与较高的 WM 显着相关损伤评分，但不包括皮质损伤。丘脑 [NAA]（≤5.6 mmol/kg/湿重）预测不良结果的准确性最高（敏感性 1.00 (95% CI 0.16-1.00)；特异性 0.95 (95% CI 0.84-0.99)）。解释 在没有 MR 可见深部脑核损伤的脑病婴儿中，丘脑 NAA 减少，可能是不良后果的有用预测因子。资助国家健康研究所 (NIHR)。