PhD Scientific Days 2021

Budapest, 7-8 July 2021

CL_V_P: Clinical Medicine V. Posters

Predictive Performance and Metabolite Dynamics of Proton MR Spectroscopy in Neonatal Hypoxic-Ischemic Encephalopathy

Hajnalka Barta1, Agnes Jermendy1, Livia Kovacs1, Noemie Schiever1, Gabor Rudas2, Miklos Szabo1

1 1st Department of Paediatrics, Division of Neonatology, Semmelweis University, Budapest, Hungary
2 Medical Imaging Centre, Department of Neuroradiology, Semmelweis University, Budapest, Hungary

Text of the abstract

Introduction: 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.
Aim: to assess the effect of GA on the predictive power of H-MRS, as well as the association between H-MRS metabolite levels and GA, PA and outcome.
Methods: 169 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 modelling, 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 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.
Conclusion: In HIE, NAA/Cr and mI/NAA gives most accurate outcome prediction throughout postnatal days 0-14. GA only affected metabolite levels in the good outcome group.
Funding: The research was supported by the ÚNKP-20-4-I New National Excellence Program of the Ministry for Innovation and Technology from the source of the National Research, Development and Innovation Fund (ÚNKP-20-4-I-SE-8), as well as by the Higher Education Institutional Excellence Program of the Ministry for Innovation and Technology in Hungary, within the framework of the Neurology thematic program of the Semmelweis University.

University and Doctoral School

Semmelweis University, Károly Rácz Doctoral School of Clinical Medicine