Abstract
Increased cerebral echodensities detected by ultrasound scanning of the brain in newborn infants often resolve, but sometimes progress to cystic periventricular leukoencephalopathy or other loss of brain tissue. The purpose of this investigation was to explore whether increased echodensities were associated with evidence of deranged cerebral energy metabolism as determined by phosphorus nuclear magnetic resonance spectroscopy (NMRS), and whether measurement of the energy status of cerebral tissue identified those infants who died or subsequently developed cysts or microcephaly.
15 normal infants born between 28 and 40 weeks of gestation were studied as controls at ages between 1 day and 14 weeks, using methods that have previously been described1. The phosphocreatine (PCr)/inorganic orthophosphate (Pi) ratio, which is an index of the energy state of the tissue, increased from 0.77 ± 0.14 (95% confidence limits) at 30 weeks of gestational age plus postnatal age to 1.12 ± 0.14 at 40 weeks.
20 infants, born at 29-41 weeks of gestation, with increased echodensities (not apparently due to haemorrhage, and associated with birth asphyxia in 9 infants) were studied by NMRS aged 1day-4weeks. PCr/Pi was below the normal range in all 5 infants who died. Sequential ultrasound scanning in the 15 survivors showed no evidence of loss of brain substance in the 5 infants whose PCr/Pi ratios were within the normal range, whereas cysts or microcephaly developed in 8 of the 10 infants whose ratios were abnormally low (Fisher's exact test, p<0.01).
We conclude that (1) cerebral energy status was abnormal in some infants with increased cerebral echodensities and (2), the infants with abnormal energy status were much more likely to die or show subsequent loss of brain substance.
1. Hope PL et al. Lancet 1984; ii: 336.
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Hamilton, P., Hope, P., Cady, E. et al. DERANGED ENERGY METABOLISM IN THE BRAIN OF NEWBORN INFANTS WITH INCREASED CEREBRAL ECHCDENSITIES. Pediatr Res 19, 1078 (1985). https://doi.org/10.1203/00006450-198510000-00061
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DOI: https://doi.org/10.1203/00006450-198510000-00061