Myocardial energy metabolism was studied in newborn sheep to determine whether the metabolic responses to pacing-induced increases in heart rate were similar to those previously found during catecholamine stimulation. Open-chest newborn sheep, 3 to 9 d old (n = 11), underwent atrial pacing at a respiratory rate harmonic just above the intrinsic heart rate. Pacing rate was increased by 30 beats/min every 5 min until conduction block or a drop in systemic arterial pressure occurred. Phosphorous metabolites were monitored simultaneously (n = 7) using a 31p magnetic resonance surface coil over the heart within a magnet operating at 4.7 tesla. Myocardial oxygen consumption was monitored via an extracorporeal shunt from the coronary sinus. Rate pressure product increased with heart rate and was found to relate to myocardial oxygen consumption (r = 0.75), which increased maximally by 47 ± 9% due to increases in coronary blood flow. Phosphocreatine/ATP ratio decreased significantly, and calculated ADP increased between baseline and peak perMajor modifications in myocardial energy metabolism and regulation occur shortly after birth (1, 2). ATP production is tightly coupled to utilization in the newborn myocardium as well as the mature myocardium. However, epinephrineinduced increases in cardiac oxygen consumption and work rates in the newborn in situ are associated with corresponding changes in ATP hydrolysis products (1, 3). These high-energy phosphate alterations are not evident in the older animal. This finding would seem to indicate that the newborn myocardium, unlike the mature myocardium, uses these products, ADP and Pi' in a feedback or kinetic mode of respiratory control. Increasing cytosolic ADP and Pi would thereby stimulate mitochondrial oxidative phosphorylation. Alternatively, this relation between ADP, Pi' and oxygen consumption in the newborn may reflect developmental modifications in substrate utilization precipitated directly by exogenous catecholamines. formance but returned to near baseline levels during recovery at the initial pacing rate. These findings indicate that intracellular high-energy phosphate concentrations do change with alterations in myocardial oxygen consumption induced by cardiac pacing in the newborn. These changes are similar to those found during epinephrine infusion. Furthermore, the ATP hydrolysis products probably participate in myocardial respiratory regulation in the newborn in vivo. (Pediatr Res 37: 182-188, 1995) Abbreviations MVO z, myocardial oxygen consumption per, phosphocreatine NMR, nuclear magnetic resonance Pi' intracellular phosphate RPP, rate pressure product bpm, beats per minute NADH/NADtheoreticallyexistsinequilibriumwithphosphorylation potential, ATP/ADP'P i, and is influenced by reducing equivalent delivery or substrate supply (4). Studies performed both in perfused hearts (5) and in intact animals (6) indicate that phosphorylation potential can be altered through changes in substrate utilization without concomitant changes in oxygen consumption. Accordingly...