Brain metabolite levels were measured by proton magnetic resonance spectroscopy (MRS) and included N-acetylaspartate (NAA), creatine (Cr), choline (Cho), and lactate and the ratios NAA to Cho and Cr (NAA-Cho-Cr), NAA-Cr, NAA-Cho, and Cho-Cr. MRS findings were compared with routine and diffusion-weighted brain MRI and clinical variables in 20 infants with 1-minute Apgar scores of 6 or less at 2-28 days of age, in a study at North Shore University Hospital, Manhasset, NY, and New York University Medical College and Mt Sinai Medical Center, New York, NY.
The basal ganglia metabolite ratios NAA-Cho and NAA-ChoCr correlated with the 1-5 minute, but not with 10-min Apgar scores. Anterior border zone NAA-Cho ratios of metabolites correlated only with the 1-min Apgar scores. The basal ganglia of 3 infants with perinatal asphyxia showed elevated lactate levels. Three infants had focal MRI lesions. 
COMMENT. Infants with perinatal asphyxia at risk for cerebral palsy may be defined by a combination of neonatal clinical signs, MRS-metabolite and lactate levels, and diffusion-weighted MRI. The basal ganglia appear to be most sensitive to asphyxia and metabolite abnormalities.