This site became the new on June 19th. Learn more.
Show more Menu IMPORTANT: Listing of a study on this site does not reflect endorsement by the National Institutes of Health. Talk with a trusted healthcare professional before volunteering for a study. Read more... Menu IMPORTANT: Talk with a trusted healthcare professional before volunteering for a study. Read more... Menu
Give us feedback

Magnetic Resonance Biomarkers in Neonatal Encephalopathy (MARBLE)

This study is currently recruiting participants.
See Contacts and Locations
Verified November 2015 by Sudhin Thayyil, Thayyil, Sudhin
Information provided by (Responsible Party):
Sudhin Thayyil, Thayyil, Sudhin Identifier:
First received: March 3, 2011
Last updated: November 2, 2015
Last verified: November 2015

N-acetylaspartate (NAA) is a surrogate neuronal marker and its proton magnetic resonance spectroscopy (1H MRS) signal decreases with increasing neuronal mortality associated with cerebral hypoxia-ischaemia. The MRS lactate (Lac)/NAA peak-area ratio increases during and after severe cerebral hypoxia-ischaemia reflecting mitochondrial injury and impaired oxidative phosphorylation.

Aims: (1) To establish normative ranges for thalamic 1H MRS NAA concentration and Lac/NAA in healthy newborn infants (2) To examine the accuracies of thalamic 1H MRS NAA concentration and Lac/NAA for predicting adverse neurodevelopmental outcome in neonatal encephalopathy (NE)

Design: Prospective observational study Methods: Year 1: Following 1H MRS methodology optimisation 40 healthy control infants will be recruited to collect normative data. Year 2 to 3: 115 infants with NE, undergoing therapeutic hypothermia will be recruited. MRS will be performed aged less than 4 days and 7 to 14 days and thalamic NAA levels and Lac/NAA will be quantified; Qualitative interviews to evaluate parental understanding of this biomarker. Year 4, 5: Outcome assessment by BSID III at 18 months.

Outcomes: Mean thalamic NAA levels and Lac/NAA and appropriate confidence intervals in normal infants, and thalamic NAA levels and Lac/NAA in infants with NE according to neurodevelopmental outcome. Areas under curves for thalamic NAA and Lac/NAA will be examined separately for early & late MRS. Accuracy of early MRS will inform utility of this investigation in decisions about withdrawal of life support; late MRS will inform about efficacy as a surrogate end point in clinical trials. Qualitative interviews will be thematically analysed and reported.

Neonatal Encephalopathy

Study Type: Observational
Study Design: Observational Model: Cohort
Time Perspective: Prospective
Official Title: A Multicentre Prospective Study on Magnetic Resonance Biomarkers in Neonatal Encephalopathy

Further study details as provided by Sudhin Thayyil, Thayyil, Sudhin:

Primary Outcome Measures:
  • Prognostic accuracy of [NAA] [ Time Frame: 18 months ]
    Assessed by BSID 3

Biospecimen Retention:   Samples With DNA
Blood and urine

Estimated Enrollment: 180
Study Start Date: March 2011
Estimated Study Completion Date: March 2016
Estimated Primary Completion Date: March 2016 (Final data collection date for primary outcome measure)
Moderate of severe neonatal encephalopathy

  Show Detailed Description


Ages Eligible for Study:   up to 45 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Sampling Method:   Non-Probability Sample
Study Population
Healthy control infants, Infants with Neonatal encephalopathy, Healthy adult volunteers

Inclusion Criteria:

  • Group I (Controls): Healthy newborn infants (gestation 36 to 43 weeks, birth weight >2.7 kg)
  • Group II (NE): Infants 36 to 43 weeks gestation with at least one of the following:

    • Evidence of perinatal asphyxia as indicated by
    • Apgar score of <5 at 5 minutes after birth
    • Continued need for resuscitation, including endotracheal or mask ventilation, at 5 minutes after birth
    • Acidosis defined as pH <7.00 and/or base deficit >16 mmol/L in umbilical cord blood sample or any blood sample within 60 minutes of birth (arterial or venous blood) AND
  • Moderate to severe encephalopathy consisting of altered state of consciousness (reduced or absent response to stimulation) and hypotonia, and abnormal primitive reflexes (weak or absent suck or Moro response). Clinical NE severity will be assessed by Thompson encephalopathy score.
  • Group III (Healthy adult volunteers): Same individual will be scanned multiple times at each of the centres to examine intra and inter-centre variability of thalamic [NAA].

Exclusion Criteria:

  • Life threatening congenital malformations
  • Syndromic infants
  • Metabolic disorders
  • Meningitis or encephalitis
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01309711

Contact: Sudhin Thayyil, PhD 00447912888700

United Kingdom
Sudhin Thayyil Recruiting
London, United Kingdom
Contact: Sudhin Thayyil, PhD         
Sponsors and Collaborators
Thayyil, Sudhin
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Sudhin Thayyil, Consultant Neonatologist, Thayyil, Sudhin Identifier: NCT01309711     History of Changes
Other Study ID Numbers: MARBLE
Study First Received: March 3, 2011
Last Updated: November 2, 2015

Keywords provided by Sudhin Thayyil, Thayyil, Sudhin:
Neonatal encephalopathy
Therapeutic hypothermia

Additional relevant MeSH terms:
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases processed this record on September 21, 2017