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Updated: Jul 29, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Relation of deranged neonatal cerebral oxidative metabolism with neurodevelopmental outcome and head circumference at
Insights
Neonatal brain energy metabolism, measured by cerebral phosphocreatine to inorganic phosphate ratios, strongly predicts neurodevelopmental outcomes in infants with birth asphyxia. Impaired energy metabolism correlates with death and long-term impairments.
Area of Science:
- Neuroscience
- Biochemistry
- Pediatrics
Background:
- Birth asphyxia poses a significant risk for neonatal brain injury.
- Assessing early markers of brain injury is crucial for predicting long-term outcomes.
- Cerebral energy metabolism is a key indicator of brain health.
Purpose of the Study:
- To investigate the relationship between cerebral oxidative metabolism in the first week of life and neurodevelopmental outcomes at 4 years in infants with birth asphyxia.
- To determine if early metabolic derangement predicts adverse outcomes.
Main Methods:
- Phosphorus magnetic resonance spectroscopy (31P-MRS) was used to measure cerebral oxidative metabolism (phosphocreatine:inorganic phosphate ratio) in 62 infants with birth asphyxia during the first week of life.
- Neurodevelopmental outcomes were assessed at 4 years in surviving infants using a range of tests.
- Statistical analyses correlated metabolic values with outcomes.
Main Results:
- Significant relationships were found between the degree of deranged neonatal oxidative metabolism and adverse outcomes.
- Outcomes included death, reduced head growth, neuromotor impairments, overall neurodevelopmental impairments, and cognitive functioning deficits at 4 years.
- Strong correlations were observed between the extent of metabolic derangement and outcomes at 1 and 4 years.
Conclusions:
- The severity of adverse outcomes in infants with birth asphyxia is closely related to the degree of cerebral energy derangement in the first week of life.
- Primary intrapartum hypoxic-ischaemic cerebral injury is a major cause of death, microcephaly, and impaired development in these infants.
Abstract:
Cerebral oxidative metabolism was studied using phosphorus magnetic resonance spectroscopy during the first week of life and neurodevelopmental outcome was assessed at 4 years in 62 infants who had clinical and/or biochemical evidence consistent with birth asphyxia (critically impaired intrapartum gas exchange). Twenty-one died and the neurodevelopmental status of the 41 who survived was assessed by a range of tests at age 4 years. The minimum recorded values for the cerebral phosphocreatine:inorganic phosphate concentration ratio (an index of oxidative metabolism) were related to outcome. The results showed significant relations between the extent of derangement of neonatal oxidative metabolism and a range of adverse outcomes, including death, and at 4 years reduced head growth and the presence and severity of neuromotor impairments, overall neurodevelopmental impairments, and cognitive functioning. Strong correlations between the extent of derangement of neonatal oxidative metabolism and outcome at 1 and 4 years were also shown. We conclude that the severities of adverse outcomes at 1 and 4 years of age were closely related to the extent of cerebral energy derangement in the first week of life, and we also conclude that primary intrapartum hypoxic-ischaemic cerebral injury was generally responsible for the events that led to death, microcephaly, and impaired
