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Brain alkaline intracellular pH after neonatal encephalopathy
Nicola J Robertson1, Frances M Cowan, I Jane Cox
1Department of Paediatrics, Division of Paediatrics, Obstetrics and Gynaecology, Imperial College School of Science, Technology and Medicine, Hammersmith Hospital Campus, DuCane Road, LondonW12 0NN, UK. n.robertson@ic.ac.uk
Annals of Neurology
|November 26, 2002
Summary
Hypoxia-ischemia in newborns causes an alkaline shift in brain intracellular pH (pH(i)). This brain alkalosis is linked to poorer neurodevelopmental outcomes and increased lactate/creatine levels in infants.
Area of Science:
- Neonatal Neurology
- Neurocritical Care
- Pediatric Neuroimaging
Background:
- Hypoxia-ischemia (HI) can lead to neonatal encephalopathy.
- Experimental studies show an alkaline shift in brain intracellular pH (pH(i)) post-HI.
Purpose of the Study:
- Assess brain pH(i) in infants with neonatal encephalopathy during the first two weeks.
- Correlate brain pH(i) with MRI findings, neurodevelopmental outcomes, and lactate/creatine levels.
- Determine the duration of alkaline brain pH(i) in relation to outcomes.
Main Methods:
- Utilized magnetic resonance (MR) techniques on 78 term infants with neonatal encephalopathy.
- Calculated brain pH(i) using phosphorus-31 MR spectroscopy.
- Measured brain lactate/creatine ratios with proton MRS.
Main Results:
- Infants with severely abnormal MRI showed significantly higher brain pH(i) (7.24) compared to those with normal MRI (7.04) in the first two weeks.
- Higher brain pH(i) was associated with cerebral atrophy, severe neurodevelopmental impairment, and mortality.
- Brain alkalosis correlated with increased brain lactate/creatine and persisted longer in infants with severe outcomes.
Conclusions:
- Alkaline brain pH(i) in the early neonatal period is associated with adverse neurodevelopmental outcomes in neonatal encephalopathy.
- Elevated brain lactate/creatine levels are linked to this early brain alkalosis.
- Persistent brain alkalosis may indicate a more severe injury and poorer prognosis.