A combined a-EEG and MR spectroscopy study in term newborns with hypoxic-ischemic encephalopathy

Objectives: Brain damage following a perinatal hypoxic-ischemic (HI) insult has been documented by different diagnostic techniques. The aim of the present study was to relate a-EEG time course during the first 24 h of life to brain metabolic changes detected by proton MR spectroscopy (H-1-MRS) at 7-10 days of life and to evaluate their correlation with outcome. Methods: Thirty-two patients with any grade HI encephalopathy were studied. Thirty-one out of 32 patients survived and underwent H-1-MRS examination at 7-10 days of life; a-EEG was recorded during the first 24 h of life in 27/32 newborns; 26 patients underwent both examinations. Griffiths test, evaluation of motor skills, visual and hearing function were performed at regular intervals until the age of 2 years. Results: a-EEG at 6,12 and 24 h of life showed a significant correlation with outcome. N-acetyl-aspartate/creatine (Cr), Lactate/Cr and myo-inositol differed significantly between patients with normal or poor outcome. a-EEG time course during the first 24 h of life showed improvement in newborns with normal H-1-MRS and good outcome and a deterioration in those with abnormal H-1-MRS and poor outcome. Conclusions: a-EEG time course may be able to document the severity and the evolution of the cerebral damage following an HI event. a-EEG is related to the severity of cerebral injury as defined by 1H-MRS and both examinations showed a good correlation with outcome. These data, obtained in non-cooled infants, may represent reference data for future investigations in cooled infants. (C) 2009 Elsevier B.V. All rights reserved.