Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy
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...
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| Veröffentlicht in: | Pediatric research 2022-02, Vol.91 (3), p.581-589 |
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| creator | Barta, Hajnalka Jermendy, Agnes Kovacs, Livia Schiever, Noemie Rudas, Gabor Szabo, Miklos |
| description | 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
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| doi_str_mv | 10.1038/s41390-021-01626-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8904256</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2637579312</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-afd4d4be8124bfa8127572b0d522a65867c084a296e71cbe577a8c8d40cd08f13</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi1ERQ8HXoAFssSGTahviZ0NEqq4SUUgBGvLcSaNq8QOts8R6Yp34A15EkxPWy4LViN5_vk9_3wIPaLkGSVcnSRBeUsqwmhFaMOa6vIO2tCalych5F20IYTTiretOkb3U7oghIpaiXvomAuh2pqzDdp_iNA7m90e8AJxCHE23gI2vsczZNOFyWXA_erN7GzCYcBLDDl4_O4jTgvYHEOyYVmx89hD8CabCY_rEr46--Pbd5fsCGUSQ3FdRjOFxeRxfYCOBjMleHhdt-jzq5efTt9UZ-9fvz19cVZZIUWuzNCLXnSgKBPdYEqRtWQd6WvGTFOrRlqihGFtA5LaDmopjbKqF8T2RA2Ub9Hzg--y62boLfgczaSX6GYTVx2M0393vBv1edhr1RLB6qYYPL02iOHLDlLWc4kE02RK2F3SrJaEUiEKkC168o_0IuyiL_E0a3hZvOWUFRU7qGw5XIow3C5Dif6FVR-w6oJVX2HVl2Xo8Z8xbkduOBYBPwhSaflziL___o_tTxGVsr4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2637579312</pqid></control><display><type>article</type><title>Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Barta, Hajnalka ; Jermendy, Agnes ; Kovacs, Livia ; Schiever, Noemie ; Rudas, Gabor ; Szabo, Miklos</creator><creatorcontrib>Barta, Hajnalka ; Jermendy, Agnes ; Kovacs, Livia ; Schiever, Noemie ; Rudas, Gabor ; Szabo, Miklos</creatorcontrib><description>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
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.
Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome.
However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared.
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.</description><identifier>ISSN: 0031-3998</identifier><identifier>EISSN: 1530-0447</identifier><identifier>DOI: 10.1038/s41390-021-01626-z</identifier><identifier>PMID: 34489532</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>Aspartic Acid ; Brain damage ; Choline ; Clinical ; Clinical Research Article ; Creatine - metabolism ; Gestational age ; Humans ; Hypoxia ; Hypoxia-Ischemia, Brain - diagnostic imaging ; Hypoxia-Ischemia, Brain - metabolism ; Infant, Newborn ; Inositol ; Medicine ; Medicine & Public Health ; Pediatric Surgery ; Pediatrics ; Proton Magnetic Resonance Spectroscopy ; Protons ; Spectrum analysis</subject><ispartof>Pediatric research, 2022-02, Vol.91 (3), p.581-589</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-afd4d4be8124bfa8127572b0d522a65867c084a296e71cbe577a8c8d40cd08f13</citedby><cites>FETCH-LOGICAL-c474t-afd4d4be8124bfa8127572b0d522a65867c084a296e71cbe577a8c8d40cd08f13</cites><orcidid>0000-0001-7870-8090</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34489532$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barta, Hajnalka</creatorcontrib><creatorcontrib>Jermendy, Agnes</creatorcontrib><creatorcontrib>Kovacs, Livia</creatorcontrib><creatorcontrib>Schiever, Noemie</creatorcontrib><creatorcontrib>Rudas, Gabor</creatorcontrib><creatorcontrib>Szabo, Miklos</creatorcontrib><title>Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy</title><title>Pediatric research</title><addtitle>Pediatr Res</addtitle><addtitle>Pediatr Res</addtitle><description>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
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.
Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome.
However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared.
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.</description><subject>Aspartic Acid</subject><subject>Brain damage</subject><subject>Choline</subject><subject>Clinical</subject><subject>Clinical Research Article</subject><subject>Creatine - metabolism</subject><subject>Gestational age</subject><subject>Humans</subject><subject>Hypoxia</subject><subject>Hypoxia-Ischemia, Brain - diagnostic imaging</subject><subject>Hypoxia-Ischemia, Brain - metabolism</subject><subject>Infant, Newborn</subject><subject>Inositol</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Proton Magnetic Resonance Spectroscopy</subject><subject>Protons</subject><subject>Spectrum analysis</subject><issn>0031-3998</issn><issn>1530-0447</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctu1TAQhi1ERQ8HXoAFssSGTahviZ0NEqq4SUUgBGvLcSaNq8QOts8R6Yp34A15EkxPWy4LViN5_vk9_3wIPaLkGSVcnSRBeUsqwmhFaMOa6vIO2tCalych5F20IYTTiretOkb3U7oghIpaiXvomAuh2pqzDdp_iNA7m90e8AJxCHE23gI2vsczZNOFyWXA_erN7GzCYcBLDDl4_O4jTgvYHEOyYVmx89hD8CabCY_rEr46--Pbd5fsCGUSQ3FdRjOFxeRxfYCOBjMleHhdt-jzq5efTt9UZ-9fvz19cVZZIUWuzNCLXnSgKBPdYEqRtWQd6WvGTFOrRlqihGFtA5LaDmopjbKqF8T2RA2Ub9Hzg--y62boLfgczaSX6GYTVx2M0393vBv1edhr1RLB6qYYPL02iOHLDlLWc4kE02RK2F3SrJaEUiEKkC168o_0IuyiL_E0a3hZvOWUFRU7qGw5XIow3C5Dif6FVR-w6oJVX2HVl2Xo8Z8xbkduOBYBPwhSaflziL___o_tTxGVsr4</recordid><startdate>20220201</startdate><enddate>20220201</enddate><creator>Barta, Hajnalka</creator><creator>Jermendy, Agnes</creator><creator>Kovacs, Livia</creator><creator>Schiever, Noemie</creator><creator>Rudas, Gabor</creator><creator>Szabo, Miklos</creator><general>Nature Publishing Group US</general><general>Nature Publishing Group</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7870-8090</orcidid></search><sort><creationdate>20220201</creationdate><title>Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy</title><author>Barta, Hajnalka ; Jermendy, Agnes ; Kovacs, Livia ; Schiever, Noemie ; Rudas, Gabor ; Szabo, Miklos</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-afd4d4be8124bfa8127572b0d522a65867c084a296e71cbe577a8c8d40cd08f13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aspartic Acid</topic><topic>Brain damage</topic><topic>Choline</topic><topic>Clinical</topic><topic>Clinical Research Article</topic><topic>Creatine - metabolism</topic><topic>Gestational age</topic><topic>Humans</topic><topic>Hypoxia</topic><topic>Hypoxia-Ischemia, Brain - diagnostic imaging</topic><topic>Hypoxia-Ischemia, Brain - metabolism</topic><topic>Infant, Newborn</topic><topic>Inositol</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Proton Magnetic Resonance Spectroscopy</topic><topic>Protons</topic><topic>Spectrum analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barta, Hajnalka</creatorcontrib><creatorcontrib>Jermendy, Agnes</creatorcontrib><creatorcontrib>Kovacs, Livia</creatorcontrib><creatorcontrib>Schiever, Noemie</creatorcontrib><creatorcontrib>Rudas, Gabor</creatorcontrib><creatorcontrib>Szabo, Miklos</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barta, Hajnalka</au><au>Jermendy, Agnes</au><au>Kovacs, Livia</au><au>Schiever, Noemie</au><au>Rudas, Gabor</au><au>Szabo, Miklos</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy</atitle><jtitle>Pediatric research</jtitle><stitle>Pediatr Res</stitle><addtitle>Pediatr Res</addtitle><date>2022-02-01</date><risdate>2022</risdate><volume>91</volume><issue>3</issue><spage>581</spage><epage>589</epage><pages>581-589</pages><issn>0031-3998</issn><eissn>1530-0447</eissn><abstract>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
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.
Overall, neither metabolite ratio was affected by gestational age nor by postnatal age, while they showed the strongest association with neurological outcome.
However, in newborns facing good outcome, metabolite ratios were associated with gestational age, whereas in cases facing poor outcome, this association disappeared.
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.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>34489532</pmid><doi>10.1038/s41390-021-01626-z</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-7870-8090</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Pediatric research, 2022-02, Vol.91 (3), p.581-589 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aspartic Acid Brain damage Choline Clinical Clinical Research Article Creatine - metabolism Gestational age Humans Hypoxia Hypoxia-Ischemia, Brain - diagnostic imaging Hypoxia-Ischemia, Brain - metabolism Infant, Newborn Inositol Medicine Medicine & Public Health Pediatric Surgery Pediatrics Proton Magnetic Resonance Spectroscopy Protons Spectrum analysis |
| title | Predictive performance and metabolite dynamics of proton MR spectroscopy in neonatal hypoxic–ischemic encephalopathy |
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