ABSTRACT:The aim of this study was to evaluate the hypothesis that cerebral hemoglobin (Hb) oxygenation is related to phosphorylation potential during primary and secondary cerebral energy failure in newborn infants who have experienced birth asphyxia. We subjected newborn piglets to severe transient cerebral hypoxic-ischemia followed by resuscitation and examined cerebral energy metabolism by 31 P-magnetic resonance spectroscopy and evaluated changes in cerebral Hb oxygen saturation (ScO 2 ) using full-spectrum nearinfrared spectroscopy before, during, and up to 54 h after the hypoxic-ischemic insult. ScO 2 was significantly decreased during the hypoxic-ischemic insult compared with baseline values. During secondary energy failure, piglets were separated based on the relationship between the ratio of phosphocreatine to inorganic phosphate and ScO 2 ; those with a negative correlation were less injured than those with a positive correlation. These results indicate that changes in ScO 2 as measured by near-infrared spectroscopy are related to phosphorylation potential during secondary energy failure in asphyxiated infants. (Pediatr Res 65: 317-322, 2009) H ypoxic-ischemic encephalopathy remains a major cause of permanent neurodevelopmental disability and infant mortality. Phosphorus nuclear magnetic resonance spectroscopy ( 31 P-MRS) has shown that on the first day of life there are no differences in the high-energy phosphate metabolites found in the brains of infants who have experienced birth asphyxia and normal infants (1,2). However, over the next several days, inverse changes in the concentrations of phosphocreatine (PCr) and inorganic phosphate (Pi) cause a significant reduction in the ͓PCr͔/͓Pi͔ ratio of asphyxiated infants, despite optimal medical management. Low values of ͓PCr͔/͓Pi͔ were found to be associated with very poor prognoses for survival and early neurodevelopmental outcome (1,2). The late metabolic deterioration that is characteristic of asphyxiated infants indicates the existence of metabolic stress and implies that there may be a therapeutic window during which appropriate therapy could improve outcomes.Near-infrared spectroscopy (NIRS), which uses light in the near-infrared range, can detect changes in the oxygenation state of hemoglobin (Hb) and water in biologic tissues. Several studies have shown the usefulness of NIRS as a noninvasive means of measuring hemodynamic changes in infants (3-10), particularly for quantifying cerebral blood volume (CBV) during small-induced changes in arterial oxygen saturation (4,7), for quantifying cerebral blood flow with rapid changes in oxyHb (or indocyanine green as an intravascular tracer) (5,8,9), and for quantifying cerebrovenous oxygen saturation during downward tilting of the head or jugular venous occlusion (10).Cerebral vascular Hb oxygen saturation (ScO 2 ) is another parameter that can be measured in absolute terms using NIRS without manipulating inspired oxygen concentration or impeding venous outflow. The output value is the weighted average ...