@article {MitraF424, author = {Subhabrata Mitra and Giles S Kendall and Alan Bainbridge and Magdalena Sokolska and Mary Dinan and Cristina Uria-Avellanal and David Price and Katie Mckinnon and Roxana Gunny and Angela Huertas-Ceballos and Xavier Golay and Nicola J Robertson}, title = {Proton magnetic resonance spectroscopy lactate/N-acetylaspartate within 2 weeks of birth accurately predicts 2-year motor, cognitive and language outcomes in neonatal encephalopathy after therapeutic hypothermia}, volume = {104}, number = {4}, pages = {F424--F432}, year = {2019}, doi = {10.1136/archdischild-2018-315478}, publisher = {BMJ Publishing Group}, abstract = {Objective Brain proton (1H) magnetic resonance spectroscopy (MRS) lactate/N-acetylaspartate (Lac/NAA) peak area ratio is used for prognostication in neonatal encephalopathy (NE). At 3 Tesla in NE babies, the objectives were to assess: (1) sensitivity and specificity of basal ganglia and thalamus (BGT) 1H MRS Lac/NAA for the prediction of Bayley III outcomes at 2 years using optimised metabolite fitting (Tarquin) with threonine and total NAA; (2) prediction of motor outcome with diffusion-weighted MRI; (3) BGT Lac/NAA correlation with the National Institute of Child Health and Human Development (NICHD) MRI score.Subjects and methods 55 (16 inborn, 39 outborn) infants at 39w+5 d (35w+5d{\textendash}42w+0d) with NE admitted between February 2012 and August 2014 to University College London Hospitals for therapeutic hypothermia underwent MRI and 1H MRS at 3T on day 2{\textendash}14 (median day 5). MRIs were scored. Bayley III was assessed at 24 (22{\textendash}26) months.Results 16 babies died (1 inborn, 15 outborn); 20, 19 and 21 babies had poor motor, cognitive and language outcomes. Using a threshold of 0.39, sensitivity and specificity of BGT Lac/NAA for 2-year motor outcome was 100\% and 97\%, cognition 90\% and 97\% and language 81\% and 97\%, respectively. Sensitivity and specificity for motor outcome of mean diffusivity (threshold 0.001 mm2/s) up to day 9 was 72\% and 100\% and fractional anisotropy (threshold 0.198) was 39\% and 94\%, respectively. Lac/NAA correlated with BGT injury on NICHD scores (2A, 2B, 3).Conclusion BGT Lac/NAA on 1H MRS at 3T within 14 days accurately predicts 2-year motor, cognitive and language outcome and may be a marker directing decisions for therapies after cooling.}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/104/4/F424}, eprint = {https://fn.bmj.com/content/104/4/F424.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }