Background PG is a commonly used excipient contained in several medications to control neonatal seizures (Phenobarbitone (PhB) (79%) Phenytoin (Ph) (40%) and Clonazepam). On MRS the appearance of a doublet at 1.1 ppm in some spectra is attributed to PG. The lower safe level of short term exposure to PG in neonates is 35 mg/kg/24 hrs however safe brain levels are unknown.
Objective To determine the PG levels in MRS of infants with NE.
Design/methods MRS between July 2010 and August 2013 were reviewed in infants with NE (PRESS sequence TE: 288ms) All MRS spectra were reviewed by an MR Physicist. Cases with an observable doublet at 1.1 ppm were reprocessed with Tarquin V4.3.2 using a simulated basis set the included PG and referenced to unsurpassed water signal to obtain institutional units of concentration.
Results 29 infants with NE. MRI was performed at mean age of 120 hrs (35–197 hrs) Diagnosis HIE (27), Congenital lactic acidosis (1) GBS meningitis (1) MCA infarction (1) PG was present in 24% of infants (n = 7). The mean level on MRS was 10.76 mM (2.11–26.48).
All infants with PG peaks received 40mg/kg PhB, and 18 mg/kg Ph and 6/7 received Clonazepam. No PG group required less anticonvulsants (13.6% no treatment, 63% PhB, 23% PhB and Ph).
Conclusions PG is detected on MRS in NE infants.
The level may correlate with underlying diagnosis. PG accumulation may have clinical implications which need to be further investigated. Additionally PG must be correctly differentiated from lactate on MRS.
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