Abstract
Studies of the brains of severely birth-asphyxiated infants using proton(1H) magnetic resonance spectroscopy (MRS) have shown changes indicating a rise in cerebral lactate (Lac) and a fall in N- acetylaspartate (Naa). The aim of this study was to test two hypotheses: 1) that these changes can be reproduced in the newborn piglet after transient reversed cerebral hypoxia-ischemia, and their time course determined; and 2) that changes in Lac peak-area ratios are related to changes in phosphorylation potential as determined by phosphorus(31P) MRS. Eighteen piglets aged <24 h were anesthetized and ventilated. Twelve underwent temporary occlusion of the carotid arteries and hypoxemia, and six served as sham-operated controls. 1H and 31P spectra were acquired alternately, both during the insult and for the next 48 h, using a 7-tesla spectrometer. During hypoxia-ischemia, the median Lac/total creatine (Cr) peak-area ratio rose from a baseline of 0.14 (interquartile range 0.07-0.27), to a maximum of 4.34 (3.33-7.45). After resuscitation, Lac/Cr fell to 0.75 (0.45-1.64) by 2 h, and then increased again to 2.43(1.13-3.08) by 48 h. At all stages after resuscitation Lac/Cr remained significantly above baseline and control values. Naa/Cr was significantly reduced below baseline and control values by 48 h after resuscitation. The increases in the Lac peak-area ratios were concomitant with the falls in the[phosphocreatine (PCr)*]/[inorganic phosphate (Pi)] ratio, during both acute hypoxia-ischemia and delayed energy failure. The maximum Lac/Naa during delayed energy failure correlated strongly with the minimum[nucleotide triphosphate (NTP)]/[exchangeable phosphate pool (EPP)](r = -0.94, p < 0.0001). We conclude that both hypotheses have been confirmed.
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Abbreviations
- Cho:
-
choline-containing compounds
- Cr:
-
creatine plus phosphocreatine
- EPP:
-
exchangeable phosphate pool
- FID:
-
free induction decay
- 1H:
-
proton
- Lac:
-
lactate
- MABP:
-
mean arterial blood pressure
- MRS:
-
magnetic resonance spectroscopy
- Naa:
-
N- acetylaspartate
- NTP:
-
nucleotide triphosphate
- PCr:
-
phosphocreatine
- pHi:
-
intracellular pH
- Pi:
-
inorganic phosphate
- ppm:
-
parts per million
- PRESS:
-
point-resolved spectroscopy
- T 2 :
-
transverse relaxation time
- TR:
-
repetition time
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The authors thank Richard Aldridge for his invaluable technical assistance.
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Supported by the Medical Research Council, UK, and the Wellcome Trust.
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Penrice, J., Lorek, A., Cady, E. et al. Proton Magnetic Resonance Spectroscopy of the Brain during Acute Hypoxia-Ischemia and Delayed Cerebral Energy Failure in the Newborn Piglet. Pediatr Res 41, 795–802 (1997). https://doi.org/10.1203/00006450-199706000-00001
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DOI: https://doi.org/10.1203/00006450-199706000-00001
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