Pediatric Research ( IF 3.1 ) Pub Date : 2021-09-06 , DOI: 10.1038/s41390-021-01626-z Hajnalka Barta 1 , Agnes Jermendy 1 , Livia Kovacs 1 , Noemie Schiever 1 , Gabor Rudas 2 , Miklos Szabo 1
Background
Prognostic value of proton MR spectroscopy (H-MRS) in hypoxic–ischemic encephalopathy (HIE) is acknowledged; however, effects of gestational age (GA) and postnatal age (PA) on prediction and metabolite levels are unknown.
Methods
One hundred and sixty-nine newborns with moderate-to-severe HIE were studied, having ≥1 H-MRS scan during postnatal days 0–14 and known neurodevelopmental outcome (Bayley-II score/cerebral palsy/death). Initial scans were categorized by PA (day 1–3/4–6/≥7), and metabolite ratios were compared by predictive value. Metabolite dynamics were assessed in a total of 214 scans performed in the study population, using regression modeling, with predictors GA, PA, and outcome.
Results
N-acetyl-aspartate (NAA)/creatine (Cr) and myo-inositol (mI)/NAA height ratios were consistently associated with outcome throughout the first 14 days, with the highest predictive value in the late (≥7 days) period (AUC = 0.963 and 0.816, respectively). Neither GA nor PA had an overall effect on these metabolite ratios, which showed strongest association with outcome (p < 0.001). Assessed separately in patients with good outcome, GA became a significant covariate for metabolite ratios (p = 0.0058 and 0.0002, respectively). However, this association disappeared in the poor outcome group.
Conclusions
In HIE, NAA/Cr and mI/NAA give most accurate outcome prediction throughout postnatal days 0–14. GA only affected metabolite levels in the good outcome group.
Impact
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Proton MR spectroscopy metabolite ratios N-acetyl-aspartate/creatine and myo-inositol/N-acetyl-aspartate have persistently high predictive value throughout postnatal days 0–14 in newborns with hypoxic–ischemic encephalopathy, with the highest predictive power between postnatal days 7 and 14.
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Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome.
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However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared.
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Proton MR spectroscopy provides valuable prognostic information in neonatal hypoxic–ischemic encephalopathy throughout the first 2 weeks of life, irrespective of the timing of MR scan.
中文翻译：
质子磁共振波谱在新生儿缺氧缺血性脑病中的预测性能和代谢物动力学
背景
质子磁共振波谱 (H-MRS) 在缺氧缺血性脑病 (HIE) 中的预后价值得到认可；然而，胎龄 (GA) 和出生后年龄 (PA) 对预测和代谢物水平的影响尚不清楚。
方法
研究了 169 名患有中度至重度 HIE 的新生儿，在出生后第 0-14 天进行 ≥1 次 H-MRS 扫描，并且已知神经发育结果（Bayley-II 评分/脑瘫/死亡）。初始扫描按 PA 分类（第 1-3/4-6/≥7 天），并通过预测值比较代谢物比率。代谢物动力学在研究人群中进行的总共 214 次扫描中进行了评估，使用回归模型，预测因子 GA、PA 和结果。
结果
N-乙酰-天冬氨酸 (NAA)/肌酸 (Cr) 和肌醇 (mI)/NAA 高度比始终与前 14 天的结果相关，在后期（≥7 天）期间预测值最高（ AUC = 0.963 和 0.816，分别）。GA 和 PA 对这些代谢物比率都没有总体影响，这与结果的关联性最强（p < 0.001）。在预后良好的患者中单独评估，GA 成为代谢物比率的显着协变量（分别为p = 0.0058 和 0.0002）。然而，这种关联在不良结果组中消失了。
结论
在 HIE 中，NAA/Cr 和 mI/NAA 在产后 0-14 天提供最准确的结果预测。GA 仅影响良好结果组中的代谢物水平。
影响
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质子 MR 光谱代谢物比值N-乙酰-天冬氨酸/肌酸和肌醇/ N-乙酰-天冬氨酸在缺氧缺血性脑病新生儿的产后 0-14 天内具有持续的高预测价值，在产后 7 天之间具有最高的预测能力和 14。
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总体而言，代谢物比率不受胎龄和出生后年龄的影响，而它们与神经系统结果的关联性最强。
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然而，在预后良好的新生儿中，代谢物比率与胎龄相关，而在预后不佳的情况下，这种关联消失了。
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质子 MR 波谱在出生后 2 周内为新生儿缺氧缺血性脑病提供有价值的预后信息，与 MR 扫描的时间无关。
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