Prognostic Accuracy of Thalamic Proton Magnetic Resonance Spectroscopy Following Therapeutic Hypothermia in Neonatal Encephalopathy

Abstract

Background and aims: Deep grey matter lactate/N-acetylaspartate (Lac/NAA) peak area ratio on proton magnetic resonance spectroscopy (1H MRS) is the best predictor of neurological outcome following neonatal encephalopathy (NE). We evaluated the prognostic accuracy following therapeutic hypothermia (TH).Methods: We performed magnetic resonance imaging (MRI) in consecutive term babies with NE, over a 3 year period before and after introduction of TH. Death or severe neurodisability (BSID 3) at 12 months was considered as an unfavourable outcome.Results: Of 28 babies studied, 11 babies received TH. The median (range) age at MRI was 10 (5,12) days. Thalamic Lac/NAA (>0.29) had 100% sensitivity and specificity for predicting adverse outcome in both normothermic babies and cooled infants (Table 1). The mean (SD) Lac/NAA was high in infants who had unfavorable outcome (Figure 1)Table Full size tableConclusions: The prognostic accuracy of 1H MRS deep gray matter Lac/NAA peak area ratios is unaltered by TH.