In neuroprotection trials for neonatal encephalopathy, the typical clinical outcome measures can only be measured reliably after a period of years. In a multicentre study covering eight sites and recruiting 224 infants, we demonstrate that MRS measures made within two weeks of birth provide quantitative and objective tools for predicting neurodevelopmental abnormalities usually only observed years after the initial injury. In particular, the thalamic concentration of tNAA (N-acetyl aspartate + N-acetyl aspartyl glutamate) has an area under the receiver operating characteristic curve of 0.99 (95%CI 0.98–1.00, n=82). Such tools could greatly speed up the next generation of clinical trials.
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