Beschreibung:
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>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.</jats:p>
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<jats:title>Methods</jats:title>
<jats:p>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.</jats:p>
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<jats:title>Results</jats:title>
<jats:p><jats:italic>N</jats:italic>-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 (<jats:italic>p</jats:italic> < 0.001). Assessed separately in patients with good outcome, GA became a significant covariate for metabolite ratios (<jats:italic>p</jats:italic> = 0.0058 and 0.0002, respectively). However, this association disappeared in the poor outcome group.</jats:p>
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<jats:title>Conclusions</jats:title>
<jats:p>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.</jats:p>
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<jats:title>Impact</jats:title>
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<jats:p>Proton MR spectroscopy metabolite ratios <jats:italic>N</jats:italic>-acetyl-aspartate/creatine and myo-inositol/<jats:italic>N</jats:italic>-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.</jats:p>
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<jats:p>Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome.</jats:p>
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<jats:p>However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared.</jats:p>
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<jats:p>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.</jats:p>
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