BibTex format

author = {Lally, PJ and Montaldo, P and Oliveira, V and Soe, A and Swamy, R and Bassett, P and Mendoza, J and Atreja, G and Kariholu, U and Pattnayak, S and Sashikumar, P and Harizaj, H and Mitchell, M and Ganesh, V and Harigopal, S and Dixon, J and English, P and Clarke, P and Muthukumar, P and Satodia, P and Wayte, S and Abernethy, LJ and Yajamanyam, K and Bainbridge, A and Price, D and Huertas, A and Sharp, DJ and Kalra, V and Chawla, S and Shankaran, S and Thayyil, S},
doi = {10.1016/S1474-4422(18)30325-9},
journal = {Lancet Neurology},
pages = {35--45},
title = {Magnetic resonance spectroscopy assessment of brain injury after moderate hypothermia in neonatal encephalopathy: a prospective multi-centre study},
url = {},
volume = {18},
year = {2019}

RIS format (EndNote, RefMan)

AB - BackgroundIn neonatal encephalopathy (NE), the clinical manifestations of injury can only be reliably assessed several years after an intervention, complicating early prognostication and rendering trials of promising neuroprotectants slow and expensive. We aimed to determine the accuracy of thalamic proton magnetic resonance spectroscopy (1H MRS) biomarkers as early predictors of the neurodevelopmental abnormalities observed years after NE.MethodsWe conducted a prospective multi-centre cohort study across eight neonatal intensive care units, recruiting term neonates who received therapeutic hypothermia for NE. We obtained thalamic 1H MRS 4 to 14 days after birth, which were compared to clinical neurodevelopmental tests performed 18 to 24 months later. The primary endpoint was anabnormal outcome, defined as death, or moderate or severe disability. Receiver operating characteristic (ROC) curves were used to examine the strength of the relationship between selected biomarkers and this outcome.FindingsWe recruited 223 infants who all underwent MR imaging and spectroscopy at a median (IQR) age of 7 (5 to 10) days, with 190 (85%) followed up for neurological examination at a median (IQR) age of 23 (20 to 25) months. Of those followed up, 31 (16%) had moderate or severe disability, including one death. The thalamic concentration of Nacetylasparate, [NAA], had an area under the ROC curve (AUC) of 0·99 (95% CI 0·94 to 1·00, n=82), and lactate/NAA peak area ratio had an AUC of 0·94 (95% CI 0·89 to 0·97, n=160). From conventional MRI, abnormal signal in the posterior limb of the internal capsule (PLIC) gave an AUC of 0·82 (95% CI 0·76 to 0·87, n=190). Thalamic [NAA] was independentlyassociated with neurodevelopmental outcome scores on multivariable analysis, and had higher prognostic accuracy than conventional MR imaging (98% versus 87%; p<0·001).InterpretationThalamic 1H MRS measures acquired soon after
AU - Lally,PJ
AU - Montaldo,P
AU - Oliveira,V
AU - Soe,A
AU - Swamy,R
AU - Bassett,P
AU - Mendoza,J
AU - Atreja,G
AU - Kariholu,U
AU - Pattnayak,S
AU - Sashikumar,P
AU - Harizaj,H
AU - Mitchell,M
AU - Ganesh,V
AU - Harigopal,S
AU - Dixon,J
AU - English,P
AU - Clarke,P
AU - Muthukumar,P
AU - Satodia,P
AU - Wayte,S
AU - Abernethy,LJ
AU - Yajamanyam,K
AU - Bainbridge,A
AU - Price,D
AU - Huertas,A
AU - Sharp,DJ
AU - Kalra,V
AU - Chawla,S
AU - Shankaran,S
AU - Thayyil,S
DO - 10.1016/S1474-4422(18)30325-9
EP - 45
PY - 2019///
SN - 1474-4422
SP - 35
TI - Magnetic resonance spectroscopy assessment of brain injury after moderate hypothermia in neonatal encephalopathy: a prospective multi-centre study
T2 - Lancet Neurology
UR -
UR -
VL - 18
ER -