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Massirio P, Cardiello V, Andreato C, Caruggi S, Battaglini M, Calandrino A, Polleri G, Mongelli F, Malova M, Minghetti D, Parodi A, Calevo MG, Tortora D, Rossi A, Ramenghi LA. Ventilatory Support, Extubation, and Cerebral Perfusion Changes in Pre-Term Neonates: A Near Infrared Spectroscopy Study. Neurotrauma Rep 2024; 5:409-416. [PMID: 38655113 PMCID: PMC11035839 DOI: 10.1089/neur.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Early extubation is considered to be beneficial for pre-term neonates. On the other hand, premature extubation can cause lung derecruitment, compromised gas exchange, and need for reintubation, which may be associated with severe brain injury caused by sudden cerebral blood flow changes. We used near infrared spectroscopy (NIRS) to investigate changes in cerebral oxygenation (rScO2) and fractional tissue oxygen extraction (+) after extubation in pre-term infants. This is a single-center retrospective study of NIRS data at extubation time of all consecutive pre-term neonates born at our institution over a 1-year period. Comparison between subgroups was performed. Nineteen patients were included; average gestational age (GA) was 29.4 weeks. No significant change was noted in rScO2 and cFTOE after extubation in the whole population. GA and germinal matrix hemorrhage (GMH)-intraventricular hemorrhage (IVH) showed a significant change in rScO2 and cFTOE after extubation. A significant increase in cFTOE was noted in patients with previous GMH-IVH (+0.040; p = 0.05). To conclude, extubation per se was not associated with significant change in cerebral oxygenation and perfusion. Patients with a diagnosed GMH-IVH showed an increase in cFTOE, suggesting perturbation in cerebral perfusion suggesting further understanding during this challenging phenomenon. Larger studies are required to corroborate our findings.
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Affiliation(s)
- Paolo Massirio
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Valentina Cardiello
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Andreato
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Samuele Caruggi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Marcella Battaglini
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Andrea Calandrino
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Giulia Polleri
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Federica Mongelli
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistic Unit, Scientific Direction, and IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Antonio Ramenghi
- Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and University of Genoa, Genoa, Italy
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Highton D, Caldwell M, Tachtsidis I, Elwell CE, Smith M, Cooper CE. The influence of carbon dioxide on cerebral metabolism and oxygen consumption: combining multimodal monitoring with dynamic systems modelling. Biol Open 2024; 13:bio060087. [PMID: 38180242 PMCID: PMC10810564 DOI: 10.1242/bio.060087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024] Open
Abstract
Hypercapnia increases cerebral blood flow. The effects on cerebral metabolism remain incompletely understood although studies show an oxidation of cytochrome c oxidase, Complex IV of the mitochondrial respiratory chain. Systems modelling was combined with previously published non-invasive measurements of cerebral tissue oxygenation, cerebral blood flow, and cytochrome c oxidase redox state to evaluate any metabolic effects of hypercapnia. Cerebral tissue oxygen saturation and cytochrome oxidase redox state were measured with broadband near infrared spectroscopy and cerebral blood flow velocity with transcranial Doppler ultrasound. Data collected during 5-min hypercapnia in awake human volunteers were analysed using a Fick model to determine changes in brain oxygen consumption and a mathematical model of cerebral hemodynamics and metabolism (BrainSignals) to inform on mechanisms. Either a decrease in metabolic substrate supply or an increase in metabolic demand modelled the cytochrome oxidation in hypercapnia. However, only the decrease in substrate supply explained both the enzyme redox state changes and the Fick-calculated drop in brain oxygen consumption. These modelled outputs are consistent with previous reports of CO2 inhibition of mitochondrial succinate dehydrogenase and isocitrate dehydrogenase. Hypercapnia may have physiologically significant effects suppressing oxidative metabolism in humans and perturbing mitochondrial signalling pathways in health and disease.
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Affiliation(s)
- David Highton
- Neurocritical Care Unit, University College London Hospitals, National Hospital for Neurology & Neurosurgery, London WC1N 3BG, UK
- Princess Alexandra Hospital Southside Clinical Unit, University of Queensland, Brisbane QLD 4102, Australia
| | - Matthew Caldwell
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK
| | - Ilias Tachtsidis
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK
| | - Clare E. Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK
| | - Martin Smith
- Neurocritical Care Unit, University College London Hospitals, National Hospital for Neurology & Neurosurgery, London WC1N 3BG, UK
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK
| | - Chris E. Cooper
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
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Cortese L, Fernández Esteberena P, Zanoletti M, Lo Presti G, Aranda Velazquez G, Ruiz Janer S, Buttafava M, Renna M, Di Sieno L, Tosi A, Dalla Mora A, Wojtkiewicz S, Dehghani H, de Fraguier S, Nguyen-Dinh A, Rosinski B, Weigel UM, Mesquida J, Squarcia M, Hanzu FA, Contini D, Mora Porta M, Durduran T. In vivocharacterization of the optical and hemodynamic properties of the human sternocleidomastoid muscle through ultrasound-guided hybrid near-infrared spectroscopies. Physiol Meas 2023; 44:125010. [PMID: 38061053 DOI: 10.1088/1361-6579/ad133a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Objective.In this paper, we present a detailedin vivocharacterization of the optical and hemodynamic properties of the human sternocleidomastoid muscle (SCM), obtained through ultrasound-guided near-infrared time-domain and diffuse correlation spectroscopies.Approach.A total of sixty-five subjects (forty-nine females, sixteen males) among healthy volunteers and thyroid nodule patients have been recruited for the study. Their SCM hemodynamic (oxy-, deoxy- and total hemoglobin concentrations, blood flow, blood oxygen saturation and metabolic rate of oxygen extraction) and optical properties (wavelength dependent absorption and reduced scattering coefficients) have been measured by the use of a novel hybrid device combining in a single unit time-domain near-infrared spectroscopy, diffuse correlation spectroscopy and simultaneous ultrasound imaging.Main results.We provide detailed tables of the results related to SCM baseline (i.e. muscle at rest) properties, and reveal significant differences on the measured parameters due to variables such as side of the neck, sex, age, body mass index, depth and thickness of the muscle, allowing future clinical studies to take into account such dependencies.Significance.The non-invasive monitoring of the hemodynamics and metabolism of the sternocleidomastoid muscle during respiration became a topic of increased interest partially due to the increased use of mechanical ventilation during the COVID-19 pandemic. Near-infrared diffuse optical spectroscopies were proposed as potential practical monitors of increased recruitment of SCM during respiratory distress. They can provide clinically relevant information on the degree of the patient's respiratory effort that is needed to maintain an optimal minute ventilation, with potential clinical application ranging from evaluating chronic pulmonary diseases to more acute settings, such as acute respiratory failure, or to determine the readiness to wean from invasive mechanical ventilation.
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Affiliation(s)
- Lorenzo Cortese
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, E-08860 Castelldefels (Barcelona), Spain
| | - Pablo Fernández Esteberena
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, E-08860 Castelldefels (Barcelona), Spain
| | - Marta Zanoletti
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, E-08860 Castelldefels (Barcelona), Spain
- Politecnico di Milano, Dipartimento di Fisica, I-20133 Milano, Italy
| | - Giuseppe Lo Presti
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, E-08860 Castelldefels (Barcelona), Spain
| | | | - Sabina Ruiz Janer
- IDIBAPS, Fundació Clínic per la Recerca Biomèdica, E-08036 Barcelona, Spain
| | - Mauro Buttafava
- Politecnico di Milano, Dipartimento di Elettronica Informazione e Bioingegneria, I-20133 Milano, Italy
- Now at PIONIRS s.r.l., I-20124 Milano, Italy
| | - Marco Renna
- Politecnico di Milano, Dipartimento di Elettronica Informazione e Bioingegneria, I-20133 Milano, Italy
- Now at Athinoula A. Martinos Center for Biomedical Imaging, MGH, Harvard Medical School, Charlestown, MA 02129, United States of America
| | - Laura Di Sieno
- Politecnico di Milano, Dipartimento di Fisica, I-20133 Milano, Italy
| | - Alberto Tosi
- Politecnico di Milano, Dipartimento di Elettronica Informazione e Bioingegneria, I-20133 Milano, Italy
| | | | - Stanislaw Wojtkiewicz
- University of Birmingham, School of Computer Science, Edgbaston, Birmingham, B15 2TT, United Kingdom
- Now at Nalecz Institute of Biocybernetics and Biomedical Engineering, 02-109 Warsaw, Poland
| | - Hamid Dehghani
- University of Birmingham, School of Computer Science, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | | | | | | | - Udo M Weigel
- HemoPhotonics S.L., E-08860 Castelldefels (Barcelona), Spain
| | - Jaume Mesquida
- Área de Crítics, Parc Taulí Hospital Universitari, E-08208 Sabadell, Spain
| | - Mattia Squarcia
- IDIBAPS, Fundació Clínic per la Recerca Biomèdica, E-08036 Barcelona, Spain
- Neuroradiology Department, Hospital Clínic of Barcelona, E-08036 Barcelona, Spain
| | - Felicia A Hanzu
- IDIBAPS, Fundació Clínic per la Recerca Biomèdica, E-08036 Barcelona, Spain
- Endocrinology and Nutrition Department, Hospital Clínic of Barcelona, E-08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E-28029 Madrid, Spain
| | - Davide Contini
- Politecnico di Milano, Dipartimento di Fisica, I-20133 Milano, Italy
| | - Mireia Mora Porta
- IDIBAPS, Fundació Clínic per la Recerca Biomèdica, E-08036 Barcelona, Spain
- Endocrinology and Nutrition Department, Hospital Clínic of Barcelona, E-08036 Barcelona, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), E-28029 Madrid, Spain
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, E-08860 Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), E-08010 Barcelona, Spain
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Zhou X, Xia Y, Uchitel J, Collins-Jones L, Yang S, Loureiro R, Cooper RJ, Zhao H. Review of recent advances in frequency-domain near-infrared spectroscopy technologies [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:3234-3258. [PMID: 37497520 PMCID: PMC10368025 DOI: 10.1364/boe.484044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/29/2023] [Accepted: 05/25/2023] [Indexed: 07/28/2023]
Abstract
Over the past several decades, near-infrared spectroscopy (NIRS) has become a popular research and clinical tool for non-invasively measuring the oxygenation of biological tissues, with particular emphasis on applications to the human brain. In most cases, NIRS studies are performed using continuous-wave NIRS (CW-NIRS), which can only provide information on relative changes in chromophore concentrations, such as oxygenated and deoxygenated hemoglobin, as well as estimates of tissue oxygen saturation. Another type of NIRS known as frequency-domain NIRS (FD-NIRS) has significant advantages: it can directly measure optical pathlength and thus quantify the scattering and absorption coefficients of sampled tissues and provide direct measurements of absolute chromophore concentrations. This review describes the current status of FD-NIRS technologies, their performance, their advantages, and their limitations as compared to other NIRS methods. Significant landmarks of technological progress include the development of both benchtop and portable/wearable FD-NIRS technologies, sensitive front-end photonic components, and high-frequency phase measurements. Clinical applications of FD-NIRS technologies are discussed to provide context on current applications and needed areas of improvement. The review concludes by providing a roadmap toward the next generation of fully wearable, low-cost FD-NIRS systems.
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Affiliation(s)
- Xinkai Zhou
- HUB of Intelligent Neuro-engineering (HUBIN), Aspire CREATe, IOMS, Division of Surgery and Interventional Science, University College London (UCL), London, HA7 4LP, UK
| | - Yunjia Xia
- HUB of Intelligent Neuro-engineering (HUBIN), Aspire CREATe, IOMS, Division of Surgery and Interventional Science, University College London (UCL), London, HA7 4LP, UK
- DOT-HUB, Department of Medical Physics & Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Julie Uchitel
- Department of Paediatrics, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Liam Collins-Jones
- DOT-HUB, Department of Medical Physics & Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Shufan Yang
- HUB of Intelligent Neuro-engineering (HUBIN), Aspire CREATe, IOMS, Division of Surgery and Interventional Science, University College London (UCL), London, HA7 4LP, UK
- School of Computing, Engineering & Build Environment, Edinburgh Napier University, Edinburgh, UK
| | - Rui Loureiro
- Aspire CREATe, Department of Orthopaedics & Musculoskeletal Science, UCL, London, HA7 4LP, UK
| | - Robert J. Cooper
- DOT-HUB, Department of Medical Physics & Biomedical Engineering, UCL, London, WC1E 6BT, UK
| | - Hubin Zhao
- HUB of Intelligent Neuro-engineering (HUBIN), Aspire CREATe, IOMS, Division of Surgery and Interventional Science, University College London (UCL), London, HA7 4LP, UK
- DOT-HUB, Department of Medical Physics & Biomedical Engineering, UCL, London, WC1E 6BT, UK
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Forti RM, Hobson LJ, Benson EJ, Ko TS, Ranieri NR, Laurent G, Weeks MK, Widmann NJ, Morton S, Davis AM, Sueishi T, Lin Y, Wulwick KS, Fagan N, Shin SS, Kao SH, Licht DJ, White BR, Kilbaugh TJ, Yodh AG, Baker WB. Non-invasive diffuse optical monitoring of cerebral physiology in an adult swine-model of impact traumatic brain injury. BIOMEDICAL OPTICS EXPRESS 2023; 14:2432-2448. [PMID: 37342705 PMCID: PMC10278631 DOI: 10.1364/boe.486363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/17/2023] [Accepted: 04/12/2023] [Indexed: 06/23/2023]
Abstract
In this study, we used diffuse optics to address the need for non-invasive, continuous monitoring of cerebral physiology following traumatic brain injury (TBI). We combined frequency-domain and broadband diffuse optical spectroscopy with diffuse correlation spectroscopy to monitor cerebral oxygen metabolism, cerebral blood volume, and cerebral water content in an established adult swine-model of impact TBI. Cerebral physiology was monitored before and after TBI (up to 14 days post injury). Overall, our results suggest that non-invasive optical monitoring can assess cerebral physiologic impairments post-TBI, including an initial reduction in oxygen metabolism, development of cerebral hemorrhage/hematoma, and brain swelling.
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Affiliation(s)
- Rodrigo M. Forti
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
| | - Lucas J. Hobson
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Emilie J. Benson
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tiffany S. Ko
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Nicolina R. Ranieri
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
| | - Gerard Laurent
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
| | - M. Katie Weeks
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Nicholas J. Widmann
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sarah Morton
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Anthony M. Davis
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Takayuki Sueishi
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yuxi Lin
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Karli S. Wulwick
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Nicholas Fagan
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Samuel S. Shin
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shih-Han Kao
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Daniel J. Licht
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian R. White
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Todd J. Kilbaugh
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Arjun G. Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Wesley B. Baker
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Resuscitation Science Center of Emphasis, CHOP Research Institute, Philadelphia, PA 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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6
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Charbonneau L, Chowdhury RA, Marandyuk B, Wu R, Poirier N, Miró J, Nuyt AM, Raboisson MJ, Dehaes M. Fetal cardiac and neonatal cerebral hemodynamics and oxygen metabolism in transposition of the great arteries. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:346-355. [PMID: 36565437 DOI: 10.1002/uog.26146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Hemodynamic abnormalities and brain development disorders have been reported previously in fetuses and infants with transposition of the great arteries and intact ventricular septum (TGA-IVS). A ventricular septal defect (VSD) is thought to be an additional risk factor for adverse neurodevelopment, but literature describing this population is sparse. The objectives of this study were to assess fetal cardiac hemodynamics throughout pregnancy, to monitor cerebral hemodynamics and oxygen metabolism in neonates, and to compare these data between patients with TGA-IVS, those with TGA-VSD and age-matched controls. METHODS Cardiac hemodynamics were assessed in TGA-IVS and TGA-VSD fetuses and compared with healthy controls matched for gestational age (GA) during three periods: ≤ 22 + 5 weeks (GA1), 27 + 0 to 32 + 5 weeks (GA2) and ≥ 34 + 5 weeks (GA3). Left (LVO), right (RVO) and combined (CVO) ventricular outputs, ductus arteriosus flow (DAF, sum of ante- and retrograde flow in systole and diastole), diastolic DAF, transpulmonary flow (TPF) and foramen ovale diameter were measured. Aortic (AoF) and main pulmonary artery (MPAF) flows were derived as a percentage of CVO. Fetal middle cerebral artery and umbilical artery (UA) pulsatility indices (PI) were measured and the cerebroplacental ratio (CPR) was derived. Bedside optical brain monitoring was used to measure cerebral hemoglobin oxygen saturation (SO2 ) and an index of microvascular cerebral blood flow (CBFi ), along with peripheral arterial oxygen saturation (SpO2 ), in TGA-IVS and TGA-VSD neonates. Using hemoglobin (Hb) concentration measurements, these parameters were used to derive cerebral oxygen delivery and extraction fraction (OEF), as well as an index of cerebral oxygen metabolism (CMRO2i ). These data were acquired in the early preoperative period (within 3 days after birth and following balloon atrial septostomy) and compared with those of age-matched healthy controls, and repeat measurements were collected before discharge when vital signs were stable. RESULTS LVO was increased in both TGA groups compared with controls throughout pregnancy. Compared with controls, TPF was increased and diastolic DAF was decreased in TGA-IVS fetuses throughout pregnancy, but only during GA1 and GA2 in TGA-VSD fetuses. Compared with controls, DAF was decreased in TGA-IVS fetuses throughout pregnancy and in TGA-VSD fetuses at GA2 and GA3. At GA2, AoF was higher in TGA-IVS and TGA-VSD fetuses than in controls, while MPAF was lower. At GA3, RVO and CVO were higher in the TGA-IVS group than in the TGA-VSD group. In addition, UA-PI was lower at GA2 and CPR higher at GA3 in TGA-VSD fetuses compared with TGA-IVS fetuses. Within 3 days after birth, SpO2 and SO2 were lower in both TGA groups than in controls, while Hb, cerebral OEF and CMRO2i were higher. Preoperative SpO2 was also lower in TGA-VSD neonates than in those with TGA-IVS. From preoperative to predischarge periods, SpO2 and OEF increased in both TGA groups, but CBFi and CMRO2i increased only in the TGA-VSD group. During the predischarge period, SO2 was higher in TGA-IVS than in TGA-VSD neonates, while CBFi was lower. CONCLUSIONS Fetal cardiac and neonatal cerebral hemodynamic/metabolic differences were observed in both TGA groups compared with controls. Compared to those with TGA-IVS, fetuses with TGA-VSD had lower RVO and CVO in late gestation. A higher level of preoperative hypoxemia was observed in the TGA-VSD group. Postsurgical cerebral adaptive mechanisms probably differ between TGA groups. Patients with TGA-VSD have a specific physiology that warrants further study to improve neonatal care and neurodevelopmental outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Charbonneau
- Research Centre, CHU Sainte-Justine Hospital University Centre, Montreal, Quebec, Canada
- Department of Biomedical Sciences, University of Montreal, Montreal, Quebec, Canada
| | - R A Chowdhury
- Research Centre, CHU Sainte-Justine Hospital University Centre, Montreal, Quebec, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
| | - B Marandyuk
- Research Centre, CHU Sainte-Justine Hospital University Centre, Montreal, Quebec, Canada
| | - R Wu
- Department of Fetal Cardiology, CHU Sainte-Justine Hospital University Centre, Montreal, Quebec, Canada
| | - N Poirier
- Department of Cardiac Surgery, University of Montreal, Montreal, Quebec, Canada
| | - J Miró
- Department of Fetal Cardiology, CHU Sainte-Justine Hospital University Centre, Montreal, Quebec, Canada
- Division of Pediatric Cardiology, University of Montreal, Montreal, Quebec, Canada
| | - A-M Nuyt
- Research Centre, CHU Sainte-Justine Hospital University Centre, Montreal, Quebec, Canada
- Division of Neonatology, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - M-J Raboisson
- Department of Fetal Cardiology, CHU Sainte-Justine Hospital University Centre, Montreal, Quebec, Canada
- Division of Pediatric Cardiology, University of Montreal, Montreal, Quebec, Canada
| | - M Dehaes
- Research Centre, CHU Sainte-Justine Hospital University Centre, Montreal, Quebec, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, Quebec, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Quebec, Canada
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7
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Côté-Corriveau G, Simard MN, Beaulieu O, Chowdhury RA, Gagnon MM, Gagnon M, Ledjiar O, Bernard C, Nuyt AM, Dehaes M, Luu TM. Associations between neurological examination at term-equivalent age and cerebral hemodynamics and oxygen metabolism in infants born preterm. Front Neurosci 2023; 17:1105638. [PMID: 36937667 PMCID: PMC10017489 DOI: 10.3389/fnins.2023.1105638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
Background Infants born at 29-36 weeks gestational age (GA) are at risk of experiencing neurodevelopmental challenges. We hypothesize that cerebral hemodynamics and oxygen metabolism measured by bedside optical brain monitoring are potential biomarkers of brain development and are associated with neurological examination at term-equivalent age (TEA). Methods Preterm infants (N = 133) born 29-36 weeks GA and admitted in the neonatal intensive care unit were enrolled in this prospective cohort study. Combined frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) were used from birth to TEA to measure cerebral hemoglobin oxygen saturation and an index of microvascular cerebral blood flow (CBF i ) along with peripheral arterial oxygen saturation (SpO2). In combination with hemoglobin concentration in the blood, these parameters were used to derive cerebral oxygen extraction fraction (OEF) and an index of cerebral oxygen metabolism (CMRO2i ). The Amiel-Tison and Gosselin Neurological Assessment was performed at TEA. Linear regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and GA at birth. Logistic regression models were used to assess the associations between changes in FDNIRS-DCS parameters from birth to TEA and neurological examination at TEA. Results Steeper increases in CBF i (p < 0.0001) and CMRO2i (p = 0.0003) were associated with higher GA at birth. Changes in OEF, CBF i , and CMRO2i from birth to TEA were not associated with neurological examination at TEA. Conclusion In this population, cerebral FDNIRS-DCS parameters were not associated with neurological examination at TEA. Larger increases in CBF i and CMRO2i from birth to TEA were associated with higher GA. Non-invasive bedside FDNIRS-DCS monitoring provides cerebral hemodynamic and metabolic parameters that may complement neurological examination to assess brain development in preterm infants.
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Affiliation(s)
- Gabriel Côté-Corriveau
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Marie-Noëlle Simard
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
| | - Olivia Beaulieu
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Rasheda Arman Chowdhury
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, QC, Canada
| | - Marie-Michèle Gagnon
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Mélanie Gagnon
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Omar Ledjiar
- Unité de Recherche Clinique Appliquée, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Catherine Bernard
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Anne Monique Nuyt
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
| | - Mathieu Dehaes
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, QC, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC, Canada
- *Correspondence: Mathieu Dehaes,
| | - Thuy Mai Luu
- Research Center, Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
- Thuy Mai Luu,
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8
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Yang M, Xia M, Zhang S, Wu D, Li D, Hou X, Wang D. Motion artifact correction for resting-state neonatal functional near-infrared spectroscopy through adaptive estimation of physiological oscillation denoising. NEUROPHOTONICS 2022; 9:045002. [PMID: 36284541 PMCID: PMC9587758 DOI: 10.1117/1.nph.9.4.045002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
SIGNIFICANCE Functional near-infrared spectroscopy (fNIRS) for resting-state neonatal brain function evaluation provides assistance for pediatricians in diagnosis and monitoring treatment outcomes. Artifact contamination is an important challenge in the application of fNIRS in the neonatal population. AIM Our study aims to develop a correction algorithm that can effectively remove different types of artifacts from neonatal data. APPROACH In the study, we estimate the recognition threshold based on the amplitude characteristics of the signal and artifacts. After artifact recognition, Spline and Gaussian replacements are used separately to correct the artifacts. Various correction method recovery effects on simulated artifact and actual neonatal data are compared using the Pearson correlation ( R ) and root mean square error (RMSE). Simulated data connectivity recovery is used to compare various method performances. RESULTS The neonatal resting-state data corrected by our method showed better agreement with results by visual recognition and correction, and significant improvements ( R = 0.732 ± 0.155 , RMSE = 0.536 ± 0.339 ; paired t -test, ** p < 0.01 ). Moreover, the method showed a higher degree of recovery of connectivity in simulated data. CONCLUSIONS The proposed algorithm corrects artifacts such as baseline shifts, spikes, and serial disturbances in neonatal fNIRS data quickly and more effectively. It can be used for preprocessing in clinical applications of neonatal fNIRS brain function detection.
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Affiliation(s)
- Mingxi Yang
- Beihang University, Ministry of Education, School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory of Biomechanics and Mechanobiology, Beijing, China
| | - Meiyun Xia
- Beihang University, School of Mechanical Engineering and Automation, State Key Laboratory of Virtual Reality Technology and System, Beijing, China
| | - Shen Zhang
- Beihang University, Ministry of Education, School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory of Biomechanics and Mechanobiology, Beijing, China
| | - Di Wu
- Beihang University, Ministry of Education, School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory of Biomechanics and Mechanobiology, Beijing, China
| | - Deyu Li
- Beihang University, Ministry of Education, School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory of Biomechanics and Mechanobiology, Beijing, China
- Beihang University, School of Mechanical Engineering and Automation, State Key Laboratory of Virtual Reality Technology and System, Beijing, China
| | - Xinlin Hou
- Peking University First Hospital, Department of Neonatal Ward, Beijing, China
| | - Daifa Wang
- Beihang University, Ministry of Education, School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory of Biomechanics and Mechanobiology, Beijing, China
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9
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Vadset TA, Rajaram A, Hsiao CH, Kemigisha Katungi M, Magombe J, Seruwu M, Kaaya Nsubuga B, Vyas R, Tatz J, Playter K, Nalule E, Natukwatsa D, Wabukoma M, Neri Perez LE, Mulondo R, Queally JT, Fenster A, Kulkarni AV, Schiff SJ, Grant PE, Mbabazi Kabachelor E, Warf BC, Sutin JDB, Lin PY. Improving Infant Hydrocephalus Outcomes in Uganda: A Longitudinal Prospective Study Protocol for Predicting Developmental Outcomes and Identifying Patients at Risk for Early Treatment Failure after ETV/CPC. Metabolites 2022; 12:78. [PMID: 35050201 PMCID: PMC8781620 DOI: 10.3390/metabo12010078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 01/06/2023] Open
Abstract
Infant hydrocephalus poses a severe global health burden; 80% of cases occur in the developing world where patients have limited access to neurosurgical care. Surgical treatment combining endoscopic third ventriculostomy and choroid plexus cauterization (ETV/CPC), first practiced at CURE Children's Hospital of Uganda (CCHU), is as effective as standard ventriculoperitoneal shunt (VPS) placement while requiring fewer resources and less post-operative care. Although treatment focuses on controlling ventricle size, this has little association with treatment failure or long-term outcome. This study aims to monitor the progression of hydrocephalus and treatment response, and investigate the association between cerebral physiology, brain growth, and neurodevelopmental outcomes following surgery. We will enroll 300 infants admitted to CCHU for treatment. All patients will receive pre/post-operative measurements of cerebral tissue oxygenation (SO2), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2) using frequency-domain near-infrared combined with diffuse correlation spectroscopies (FDNIRS-DCS). Infants will also receive brain imaging, to monitor tissue/ventricle volume, and neurodevelopmental assessments until two years of age. This study will provide a foundation for implementing cerebral physiological monitoring to establish evidence-based guidelines for hydrocephalus treatment. This paper outlines the protocol, clinical workflow, data management, and analysis plan of this international, multi-center trial.
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Affiliation(s)
- Taylor A. Vadset
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Ajay Rajaram
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Chuan-Heng Hsiao
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Miriah Kemigisha Katungi
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Joshua Magombe
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Marvin Seruwu
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Brian Kaaya Nsubuga
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Rutvi Vyas
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Julia Tatz
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Katharine Playter
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Esther Nalule
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Davis Natukwatsa
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Moses Wabukoma
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Luis E. Neri Perez
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Ronald Mulondo
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Jennifer T. Queally
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Aaron Fenster
- Robarts Research Institute, Western University, London, ON N6A 3K7, Canada;
| | | | - Steven J. Schiff
- Center for Neural Engineering, Center for Infectious Disease Dynamics, Departments of Engineering Science and Mechanics, Neurosurgery, and Physics, The Pennsylvania State University, University Park, PA 16802, USA;
| | - Patricia Ellen Grant
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Edith Mbabazi Kabachelor
- CURE Children’s Hospital of Uganda, Mbale P.O. Box 903, Uganda; (M.K.K.); (J.M.); (M.S.); (B.K.N.); (E.N.); (D.N.); (M.W.); (R.M.); (E.M.K.)
| | - Benjamin C. Warf
- Department of Neurosurgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Jason D. B. Sutin
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Pei-Yi Lin
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (T.A.V.); (A.R.); (C.-H.H.); (R.V.); (J.T.); (K.P.); (L.E.N.P.); (P.E.G.); (J.D.B.S.)
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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10
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Rajaram A, Milej D, Suwalski M, Kebaya L, Kewin M, Yip L, de Ribaupierre S, Han V, Diop M, Bhattacharya S, St Lawrence K. Assessing cerebral blood flow, oxygenation and cytochrome c oxidase stability in preterm infants during the first 3 days after birth. Sci Rep 2022; 12:181. [PMID: 34996949 PMCID: PMC8741949 DOI: 10.1038/s41598-021-03830-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
A major concern with preterm birth is the risk of neurodevelopmental disability. Poor cerebral circulation leading to periods of hypoxia is believed to play a significant role in the etiology of preterm brain injury, with the first three days of life considered the period when the brain is most vulnerable. This study focused on monitoring cerebral perfusion and metabolism during the first 72 h after birth in preterm infants weighing less than 1500 g. Brain monitoring was performed by combining hyperspectral near-infrared spectroscopy to assess oxygen saturation and the oxidation state of cytochrome c oxidase (oxCCO), with diffuse correlation spectroscopy to monitor cerebral blood flow (CBF). In seven of eight patients, oxCCO remained independent of CBF, indicating adequate oxygen delivery despite any fluctuations in cerebral hemodynamics. In the remaining infant, a significant correlation between CBF and oxCCO was found during the monitoring periods on days 1 and 3. This infant also had the lowest baseline CBF, suggesting the impact of CBF instabilities on metabolism depends on the level of blood supply to the brain. In summary, this study demonstrated for the first time how continuous perfusion and metabolic monitoring can be achieved, opening the possibility to investigate if CBF/oxCCO monitoring could help identify preterm infants at risk of brain injury.
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Affiliation(s)
- Ajay Rajaram
- Imaging Program, Lawson Health Research Institute, London, ON, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
| | - Daniel Milej
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - Marianne Suwalski
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - Lilian Kebaya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON, N6A 3K7, Canada
| | - Matthew Kewin
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - Lawrence Yip
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - Sandrine de Ribaupierre
- Department of Medical Biophysics, Western University, London, Canada
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON, N6A 3K7, Canada
| | - Victor Han
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON, N6A 3K7, Canada
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - Soume Bhattacharya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON, N6A 3K7, Canada
| | - Keith St Lawrence
- Imaging Program, Lawson Health Research Institute, London, ON, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
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11
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Abstract
The cerebral microcirculation undergoes dynamic changes in parallel with the development of neurons, glia, and their energy metabolism throughout gestation and postnatally. Cerebral blood flow (CBF), oxygen consumption, and glucose consumption are as low as 20% of adult levels in humans born prematurely but eventually exceed adult levels at ages 3 to 11 years, which coincide with the period of continued brain growth, synapse formation, synapse pruning, and myelination. Neurovascular coupling to sensory activation is present but attenuated at birth. By 2 postnatal months, the increase in CBF often is disproportionately smaller than the increase in oxygen consumption, in contrast to the relative hyperemia seen in adults. Vascular smooth muscle myogenic tone increases in parallel with developmental increases in arterial pressure. CBF autoregulatory response to increased arterial pressure is intact at birth but has a more limited range with arterial hypotension. Hypoxia-induced vasodilation in preterm fetal sheep with low oxygen consumption does not sustain cerebral oxygen transport, but the response becomes better developed for sustaining oxygen transport by term. Nitric oxide tonically inhibits vasomotor tone, and glutamate receptor activation can evoke its release in lambs and piglets. In piglets, astrocyte-derived carbon monoxide plays a central role in vasodilation evoked by glutamate, ADP, and seizures, and prostanoids play a large role in endothelial-dependent and hypercapnic vasodilation. Overall, homeostatic mechanisms of CBF regulation in response to arterial pressure, neuronal activity, carbon dioxide, and oxygenation are present at birth but continue to develop postnatally as neurovascular signaling pathways are dynamically altered and integrated. © 2021 American Physiological Society. Compr Physiol 11:1-62, 2021.
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12
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Zhou W, Kholiqov O, Zhu J, Zhao M, Zimmermann LL, Martin RM, Lyeth BG, Srinivasan VJ. Functional interferometric diffusing wave spectroscopy of the human brain. SCIENCE ADVANCES 2021; 7:eabe0150. [PMID: 33980479 PMCID: PMC8115931 DOI: 10.1126/sciadv.abe0150] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 03/23/2021] [Indexed: 05/18/2023]
Abstract
Cerebral blood flow (CBF) is essential for brain function, and CBF-related signals can inform us about brain activity. Yet currently, high-end medical instrumentation is needed to perform a CBF measurement in adult humans. Here, we describe functional interferometric diffusing wave spectroscopy (fiDWS), which introduces and collects near-infrared light via the scalp, using inexpensive detector arrays to rapidly monitor coherent light fluctuations that encode brain blood flow index (BFI), a surrogate for CBF. Compared to other functional optical approaches, fiDWS measures BFI faster and deeper while also providing continuous wave absorption signals. Achieving clear pulsatile BFI waveforms at source-collector separations of 3.5 cm, we confirm that optical BFI, not absorption, shows a graded hypercapnic response consistent with human cerebrovascular physiology, and that BFI has a better contrast-to-noise ratio than absorption during brain activation. By providing high-throughput measurements of optical BFI at low cost, fiDWS will expand access to CBF.
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Affiliation(s)
- Wenjun Zhou
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | - Oybek Kholiqov
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | - Jun Zhu
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | - Mingjun Zhao
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA
| | - Lara L Zimmermann
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Ryan M Martin
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Bruce G Lyeth
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA
| | - Vivek J Srinivasan
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA.
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA, USA
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
- Department of Radiology, NYU Langone Health, New York, NY, USA
- Tech4Health Institute, NYU Langone Health, New York, NY, USA
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13
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Gemignani J, Gervain J. Comparing different pre-processing routines for infant fNIRS data. Dev Cogn Neurosci 2021; 48:100943. [PMID: 33735718 PMCID: PMC7985709 DOI: 10.1016/j.dcn.2021.100943] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/25/2021] [Accepted: 03/09/2021] [Indexed: 01/24/2023] Open
Abstract
Functional Near Infrared Spectroscopy (fNIRS) is an important neuroimaging technique in cognitive developmental neuroscience. Nevertheless, there is no general consensus yet about best pre-processing practices. This issue is highly relevant, especially since the development and variability of the infant hemodynamic response (HRF) is not fully known. Systematic comparisons between analysis methods are thus necessary. We investigated the performance of five different pipelines, selected on the basis of a systematic search of the infant NIRS literature, in two experiments. In Experiment 1, we used synthetic data to compare the recovered HRFs with the true HRF and to assess the robustness of each method against increasing levels of noise. In Experiment 2, we analyzed experimental data from a published study, which assessed the neural correlates of artificial grammar processing in newborns. We found that with motion artifact correction (as opposed to rejection) a larger number of trials were retained, but HRF amplitude was often strongly reduced. By contrast, artifact rejection resulted in a high exclusion rate but preserved adequately the characteristics of the HRF. We also found that the performance of all pipelines declined as the noise increased, but significantly less so than if no pre-processing was applied. Finally, we found no difference between running the pre-processing on optical density or concentration change data. These results suggest that pre-processing should thus be optimized as a function of the specific quality issues a give dataset exhibits.
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Affiliation(s)
- Jessica Gemignani
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy; Integrative Neuroscience and Cognition Center, CNRS & University of Paris, Paris, France.
| | - Judit Gervain
- Department of Developmental Psychology and Socialisation, University of Padova, Padova, Italy; Integrative Neuroscience and Cognition Center, CNRS & University of Paris, Paris, France
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14
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Harvey-Jones K, Lange F, Tachtsidis I, Robertson NJ, Mitra S. Role of Optical Neuromonitoring in Neonatal Encephalopathy-Current State and Recent Advances. Front Pediatr 2021; 9:653676. [PMID: 33898363 PMCID: PMC8062863 DOI: 10.3389/fped.2021.653676] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Neonatal encephalopathy (NE) in term and near-term infants is a significant global health problem; the worldwide burden of disease remains high despite the introduction of therapeutic hypothermia. Assessment of injury severity and effective management in the neonatal intensive care unit (NICU) relies on multiple monitoring modalities from systemic to brain-specific. Current neuromonitoring tools provide information utilized for seizure management, injury stratification, and prognostication, whilst systemic monitoring ensures multi-organ dysfunction is recognized early and supported wherever needed. The neuromonitoring technologies currently used in NE however, have limitations in either their availability during the active treatment window or their reliability to prognosticate and stratify injury confidently in the early period following insult. There is therefore a real need for a neuromonitoring tool that provides cot side, early and continuous monitoring of brain health which can reliably stratify injury severity, monitor response to current and emerging treatments, and prognosticate outcome. The clinical use of near-infrared spectroscopy (NIRS) technology has increased in recent years. Research studies within this population have also increased, alongside the development of both instrumentation and signal processing techniques. Increasing use of commercially available cerebral oximeters in the NICU, and the introduction of advanced optical measurements using broadband NIRS (BNIRS), frequency domain NIRS (FDNIRS), and diffuse correlation spectroscopy (DCS) have widened the scope by allowing the direct monitoring of oxygen metabolism and cerebral blood flow, both key to understanding pathophysiological changes and predicting outcome in NE. This review discusses the role of optical neuromonitoring in NE and why this modality may provide the next significant piece of the puzzle toward understanding the real time state of the injured newborn brain.
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Affiliation(s)
- Kelly Harvey-Jones
- Neonatology, EGA Institute for Women's Health, University College London, London, United Kingdom
| | - Frederic Lange
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Ilias Tachtsidis
- Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Nicola J Robertson
- Neonatology, EGA Institute for Women's Health, University College London, London, United Kingdom.,Edinburgh Neuroscience & Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Subhabrata Mitra
- Neonatology, EGA Institute for Women's Health, University College London, London, United Kingdom
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15
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Bale G, Mitra S, Tachtsidis I. Metabolic brain measurements in the newborn: Advances in optical technologies. Physiol Rep 2020; 8:e14548. [PMID: 32889790 PMCID: PMC7507543 DOI: 10.14814/phy2.14548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023] Open
Abstract
Neonatal monitoring in neonatal intensive care is pushing the technological boundaries of newborn brain monitoring in order to improve patient outcome. There is an urgent need of a cot side, real time monitoring for assessment of brain injury severity and neurodevelopmental outcome, in particular for term newborn infants with hypoxic-ischemic brain injury. This topical review discusses why brain tissue metabolic monitoring is important in this group of infants and introduces the currently used neuromonitoring techniques for metabolic monitoring in the neonatal intensive care unit (NICU). New optical techniques that can monitor changes in brain metabolism together with brain hemodynamics at the cot side are presented. Early studies from these emerging technologies have demonstrated their potential to deliver continuous information regarding cerebral physiological changes in sick newborn infants in real time. The promises of these new tools as well as their potential limitations are discussed.
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Affiliation(s)
- Gemma Bale
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Subhabrata Mitra
- Neonatology, EGA Institute for Women's HealthUniversity College LondonLondonUK
| | - Ilias Tachtsidis
- Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
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16
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Howarth C, Banerjee J, Leung T, Eaton S, Morris JK, Aladangady N. Cerebral Oxygenation in Preterm Infants With Necrotizing Enterocolitis. Pediatrics 2020; 146:peds.2020-0337. [PMID: 32848028 DOI: 10.1542/peds.2020-0337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preterm infants with necrotizing enterocolitis (NEC) are known to have worse neurodevelopmental outcomes, but there is no substantial evidence to support an underlying pathophysiology. We aimed to examine whether cerebral oxygenation differs in those infants who develop NEC compared to cerebral oxygenation in those who do not. METHODS We examined 48 infants <30 weeks' gestation admitted to a tertiary level NICU from October 2016 to May 2018. Infants with birth weight less than or equal to the second percentile, abnormal antenatal dopplers or twin-to-twin-transfusion-syndrome were excluded. Cerebral oximetry measurements were performed by using a near-infrared spectroscopy (NIRS) monitor weekly for 60 minutes, allowing measurement of cerebral tissue oxygenation index from the first week of life to 36 weeks postconceptional age. Weekly clinical status was also recorded. NEC was defined as greater than or equal to Bell stage 2. RESULTS The median birth weight was 884 g (range of 460-1600 g), the median weeks' gestational age was 26 + 3/7 (23 + 0/7 to 29 + 6/7), and 52% were girls. In total, 276 NIRS measurements were completed, and 7 infants developed NEC. NIRS measurements from 1 infant with NEC and 4 infants without NEC who developed hemorrhagic parenchymal infarcts were excluded from analysis. Infants who developed NEC had significantly lower cerebral tissue oxygenation index than those who did not (P = .011), even when adjusted for confounders, including gestational age, birth weight, patent ductus arteriosus, enteral feeds, sex, ethnicity, and hemoglobin. CONCLUSIONS Infants with NEC have significantly lower cerebral tissue oxygenation throughout their neonatal intensive care stay in comparison with those who did not develop NEC. This is a novel finding and could explain their worse neurodevelopmental outcome.
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Affiliation(s)
- Claire Howarth
- Homerton University Hospital National Health Service Foundation Trust, London, United Kingdom.,Queen Mary University of London, London, United Kingdom
| | - Jayanta Banerjee
- Imperial College Healthcare National Health Service Trust, London, United Kingdom.,Imperial College London, London, United Kingdom
| | - Terence Leung
- Department of Medical Physics and Biomedical Engineering and
| | - Simon Eaton
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; and
| | - Joan K Morris
- St George's, University of London, London, United Kingdom
| | - Narendra Aladangady
- Homerton University Hospital National Health Service Foundation Trust, London, United Kingdom; .,Queen Mary University of London, London, United Kingdom
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17
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Fantini S, Sassaroli A. Frequency-Domain Techniques for Cerebral and Functional Near-Infrared Spectroscopy. Front Neurosci 2020; 14:300. [PMID: 32317921 PMCID: PMC7154496 DOI: 10.3389/fnins.2020.00300] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/16/2020] [Indexed: 12/31/2022] Open
Abstract
This article reviews the basic principles of frequency-domain near-infrared spectroscopy (FD-NIRS), which relies on intensity-modulated light sources and phase-sensitive optical detection, and its non-invasive applications to the brain. The simpler instrumentation and more straightforward data analysis of continuous-wave NIRS (CW-NIRS) accounts for the fact that almost all the current commercial instruments for cerebral NIRS have embraced the CW technique. However, FD-NIRS provides data with richer information content, which complements or exceeds the capabilities of CW-NIRS. One example is the ability of FD-NIRS to measure the absolute optical properties (absorption and reduced scattering coefficients) of tissue, and thus the absolute concentrations of oxyhemoglobin and deoxyhemoglobin in brain tissue. This article reviews the measured values of such optical properties and hemoglobin concentrations reported in the literature for animal models and for the human brain in newborns, infants, children, and adults. We also review the application of FD-NIRS to functional brain studies that focused on slower hemodynamic responses to brain activity (time scale of seconds) and faster optical signals that have been linked to neuronal activation (time scale of 100 ms). Another example of the power of FD-NIRS data is related to the different regions of sensitivity featured by intensity and phase data. We report recent developments that take advantage of this feature to maximize the sensitivity of non-invasive optical signals to brain tissue relative to more superficial extracerebral tissue (scalp, skull, etc.). We contend that this latter capability is a highly appealing quality of FD-NIRS, which complements absolute optical measurements and may result in significant advances in the field of non-invasive optical sensing of the brain.
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Affiliation(s)
- Sergio Fantini
- Department of Biomedical Engineering, Tufts University, Medford, MA, United States
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18
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Kholiqov O, Zhou W, Zhang T, Du Le VN, Srinivasan VJ. Time-of-flight resolved light field fluctuations reveal deep human tissue physiology. Nat Commun 2020; 11:391. [PMID: 31959896 PMCID: PMC6971031 DOI: 10.1038/s41467-019-14228-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022] Open
Abstract
Red blood cells (RBCs) transport oxygen to tissues and remove carbon dioxide. Diffuse optical flowmetry (DOF) assesses deep tissue RBC dynamics by measuring coherent fluctuations of multiply scattered near-infrared light intensity. While classical DOF measurements empirically correlate with blood flow, they remain far-removed from light scattering physics and difficult to interpret in layered media. To advance DOF measurements closer to the physics, here we introduce an interferometric technique, surmounting challenges of bulk motion to apply it in awake humans. We reveal two measurement dimensions: optical phase, and time-of-flight (TOF), the latter with 22 picosecond resolution. With this multidimensional data, we directly confirm the unordered, or Brownian, nature of optically probed RBC dynamics typically assumed in classical DOF. We illustrate how incorrect absorption assumptions, anisotropic RBC scattering, and layered tissues may confound classical DOF. By comparison, our direct method enables accurate and comprehensive assessment of blood flow dynamics in humans.
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Affiliation(s)
- Oybek Kholiqov
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, USA
| | - Wenjun Zhou
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, USA
| | - Tingwei Zhang
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, USA
| | - V N Du Le
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, USA
| | - Vivek J Srinivasan
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, USA.
- Department of Ophthalmology and Vision Science, University of California Davis, Davis School of Medicine, Sacramento, CA, 96817, USA.
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19
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Novi SL, Roberts E, Spagnuolo D, Spilsbury BM, Price DC, Imbalzano CA, Forero E, Yodh AG, Tellis GM, Tellis CM, Mesquita RC. Functional near-infrared spectroscopy for speech protocols: characterization of motion artifacts and guidelines for improving data analysis. NEUROPHOTONICS 2020; 7:015001. [PMID: 31956662 PMCID: PMC6953699 DOI: 10.1117/1.nph.7.1.015001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/19/2019] [Indexed: 05/02/2023]
Abstract
Monitoring speech tasks with functional near-infrared spectroscopy (fNIRS) enables investigation of speech production mechanisms and informs treatment strategies for speech-related disorders such as stuttering. Unfortunately, due to movement of the temporalis muscle, speech production can induce relative movement between probe optodes and skin. These movements generate motion artifacts during speech tasks. In practice, spurious hemodynamic responses in functional activation signals arise from lack of information about the consequences of speech-related motion artifacts, as well as from lack of standardized processing procedures for fNIRS signals during speech tasks. To this end, we characterize the effects of speech production on fNIRS signals, and we introduce a systematic analysis to ameliorate motion artifacts. The study measured 50 healthy subjects performing jaw movement (JM) tasks and found that JM produces two different patterns of motion artifacts in fNIRS. To remove these unwanted contributions, we validate a hybrid motion-correction algorithm based sequentially on spline interpolation and then wavelet filtering. We compared performance of the hybrid algorithm with standard algorithms based on spline interpolation only and wavelet decomposition only. The hybrid algorithm corrected 94% of the artifacts produced by JM, and it did not lead to spurious responses in the data. We also validated the hybrid algorithm during a reading task performed under two different conditions: reading aloud and reading silently. For both conditions, we observed significant cortical activation in brain regions related to reading. Moreover, when comparing the two conditions, good agreement of spatial and temporal activation patterns was found only when data were analyzed using the hybrid approach. Overall, the study demonstrates a standardized processing scheme for fNIRS data during speech protocols. The scheme decreases spurious responses and intersubject variability due to motion artifacts.
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Affiliation(s)
- Sergio L. Novi
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | - Erin Roberts
- Misericordia University, Department of Speech-Language Pathology, Dallas, Pennsylvania, United States
| | - Danielle Spagnuolo
- Misericordia University, Department of Speech-Language Pathology, Dallas, Pennsylvania, United States
| | - Brianna M. Spilsbury
- Misericordia University, Department of Speech-Language Pathology, Dallas, Pennsylvania, United States
| | - D’manda C. Price
- Misericordia University, Department of Speech-Language Pathology, Dallas, Pennsylvania, United States
| | - Cara A. Imbalzano
- Misericordia University, Department of Speech-Language Pathology, Dallas, Pennsylvania, United States
| | - Edwin Forero
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Glen M. Tellis
- Misericordia University, Department of Speech-Language Pathology, Dallas, Pennsylvania, United States
| | - Cari M. Tellis
- Misericordia University, Department of Speech-Language Pathology, Dallas, Pennsylvania, United States
| | - Rickson C. Mesquita
- University of Campinas, Institute of Physics, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
- Address all correspondence to: Rickson C. Mesquita, E-mail:
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20
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Can Cerebral Near-infrared Spectroscopy Predict Cerebral Ischemic Events in Neurosurgical Patients? A Narrative Review of the Literature. J Neurosurg Anesthesiol 2019; 31:378-384. [DOI: 10.1097/ana.0000000000000522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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21
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Karen T, Kleiser S, Ostojic D, Isler H, Guglielmini S, Bassler D, Wolf M, Scholkmann F. Cerebral hemodynamic responses in preterm-born neonates to visual stimulation: classification according to subgroups and analysis of frontotemporal-occipital functional connectivity. NEUROPHOTONICS 2019; 6:045005. [PMID: 31720310 PMCID: PMC6832016 DOI: 10.1117/1.nph.6.4.045005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/18/2019] [Indexed: 05/07/2023]
Abstract
How neurovascular coupling develops in preterm-born neonates has been largely neglected in scientific research. We measured visually evoked (flicker light) hemodynamic responses (HRs) in preterm-born neonates ( n = 25 , gestational age: 31.71 ± 3.37 weeks, postnatal age: 25.48 ± 23.94 days) at the visual cortex (VC) and left frontotemporal lobe (FTL) using functional near-infrared spectroscopy (fNIRS) neuroimaging. We found that the HR characteristics show a large intersubject variability but could be classified into three groups according to the changes of oxyhemoglobin concentration at the VC [(A) increase, (B) decrease, or (C) inconclusive]. In groups A and B, the HRs at the left FTL were correlated with those at the VC, indicating the presence of a frontotemporal-occipital functional connectivity. Neonates in group A had a higher weight at measurement compared to those in group B, and had the lowest baseline total hemoglobin concentration and hematocrit compared to group C. To the best of our knowledge, this is the first fNIRS study showing (1) that the HRs of preterm-born neonates need to be classified into subgroups, (2) that the subgroups differed in terms of weight at measurement, and (3) that HRs can be observed also at the FTL during visual stimulation. These findings add insights into how neurovascular coupling develops in preterm-born neonates.
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Affiliation(s)
- Tanja Karen
- University Hospital Zurich, University of Zurich, Department of Neonatology, Zurich, Switzerland
- Address all correspondence to Tanja Karen, E-mail:
| | - Stefan Kleiser
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
- OxyPrem AG, Zurich, Switzerland
| | - Daniel Ostojic
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
- OxyPrem AG, Zurich, Switzerland
| | - Helene Isler
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
| | - Sabino Guglielmini
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
| | - Dirk Bassler
- University Hospital Zurich, University of Zurich, Department of Neonatology, Zurich, Switzerland
| | - Martin Wolf
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
- OxyPrem AG, Zurich, Switzerland
| | - Felix Scholkmann
- University Hospital Zurich, University of Zurich, Department of Neonatology, Biomedical Optics Research Laboratory, Zurich, Switzerland
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22
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Cheng HH, Ferradal SL, Vyas R, Wigmore D, McDavitt E, Soul JS, Franceschini MA, Newburger JW, Grant PE. Abnormalities in cerebral hemodynamics and changes with surgical intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg 2019; 159:2012-2021. [PMID: 31685276 DOI: 10.1016/j.jtcvs.2019.08.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 07/30/2019] [Accepted: 08/04/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To use novel optical techniques to measure perioperative cerebral hemodynamics of diverse congenital heart disease (CHD) groups (two-ventricle, d-transposition of the great arteries [TGA], and single ventricle [SV]) and (1) compare CHD groups with healthy controls preoperatively and (2) compare preoperative and postoperative values within each CHD group. METHODS Frequency-domain near-infrared spectroscopy and diffuse correlation spectroscopy were used to measure cerebral oxygen saturation, cerebral blood volume, cerebral blood flow index, cerebral oxygen extraction fraction (OEF, calculated using arterial oxygen saturation and cerebral oxygen saturation), and an index of cerebral metabolic rate of oxygen consumption in control and CHD neonates. Preoperative CHD measures were compared with controls. Preoperative and postoperative measures were compared within each CHD group. RESULTS In total, 31 CHD neonates (7 two-ventricle, 11 TGA, 13 SV) and 13 controls were included. Only neonates with SV CHD displayed significantly lower preoperative cerebral blood flow index (P < .04) than controls. TGA and SV groups displayed greater OEF (P < .05) during the preoperative period compared with controls. Compared with the preoperative state, postoperative neonates with TGA had a greater arterial oxygen saturation with lower OEF. CONCLUSIONS Differences in cerebral hemodynamics and oxygen metabolism were observed in diverse CHD groups compared with controls. Increased OEF appears to be a compensatory mechanism in neonates with TGA and SV. Studies are needed to understand the relationship of these metrics to outcome and their potential to guide interventions to improve outcome.
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Affiliation(s)
- Henry H Cheng
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Silvina L Ferradal
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Mass
| | - Rutvi Vyas
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Mass
| | - Daniel Wigmore
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Erica McDavitt
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Janet S Soul
- Department of Neurology, Boston Children's Hospital, Boston, Mass
| | - Mari A Franceschini
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Mass
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Boston, Mass.
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23
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Daneshvarfard F, Abrishami Moghaddam H, Dehaene-Lambertz G, Kongolo G, Wallois F, Mahmoudzadeh M. Neurodevelopment and asymmetry of auditory-related responses to repetitive syllabic stimuli in preterm neonates based on frequency-domain analysis. Sci Rep 2019; 9:10654. [PMID: 31337810 PMCID: PMC6650479 DOI: 10.1038/s41598-019-47064-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/01/2019] [Indexed: 11/20/2022] Open
Abstract
Sensory development of the human brain begins prenatally, allowing cortical auditory responses to be recorded at an early age in preterm infants. Despite several studies focusing on the temporal characteristics of preterm infants' cortical responses, few have been conducted on frequency analysis of these responses. In this study, we performed frequency and coherence analysis of preterm infants' auditory responses to series of syllables and also investigated the functional brain asymmetry of preterm infants for the detection of the regularity of auditory stimuli. Cortical auditory evoked potentials (CAEPs) were recorded in 16 preterm infants with a mean recording age of 31.48 weeks gestational age (29.57-34.14 wGA) in response to a repetitive syllabic stimulus. Peak amplitudes of the frequency response at the target frequency and the first harmonic, as well as the phase coherence (PC) at the target frequency were extracted as age-dependent variables. A functional asymmetry coefficient was defined as a lateralization index for the amplitude of the target frequency at each electrode site. While the findings revealed a significant positive correlation between the mean amplitude at the target frequency vs. age (R2 = 0.263, p = 0.042), no significant correlation was observed for age-related changes of the mean amplitude at the first harmonic. A significant correlation was also observed between the mean PC and age (R2 = 0.318, p = 0.023). A right hemisphere lateralization over many channels was also generally observed. The results demonstrate that rightward lateralization for slow rate modulation, previously observed in adults, children and newborns, appears to be in place at a very young age, even in preterm infants.
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Affiliation(s)
- Farveh Daneshvarfard
- INSERM U1105, Université de Picardie, CURS, Amiens, France
- Faculty of Electrical and Computer Engineering, K.N. Toosi University of Technology, Tehran, Iran
| | - Hamid Abrishami Moghaddam
- INSERM U1105, Université de Picardie, CURS, Amiens, France.
- Faculty of Electrical and Computer Engineering, K.N. Toosi University of Technology, Tehran, Iran.
| | - Ghislaine Dehaene-Lambertz
- Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, CNRS, Université Paris-Sud, Université Paris-Saclay, NeuroSpin Center, 91191 Gif/Yvette, France
| | - Guy Kongolo
- INSERM U1105, Université de Picardie, CURS, Amiens, France
- INSERM U1105, Neonatal ICU, South University Hospital, Amiens, France
| | - Fabrice Wallois
- INSERM U1105, Université de Picardie, CURS, Amiens, France.
- INSERM U1105, Unit Exploration Fonctionnelles du Système Nerveux Pédiatrique, South University Hospital, Amiens, France.
| | - Mahdi Mahmoudzadeh
- INSERM U1105, Université de Picardie, CURS, Amiens, France
- INSERM U1105, Unit Exploration Fonctionnelles du Système Nerveux Pédiatrique, South University Hospital, Amiens, France
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de Oliveira SR, Machado ACCP, de Paula JJ, Novi SL, Mesquita RC, Miranda DMD, Bouzada MCF. Changes of functional response in sensorimotor cortex of preterm and full-term infants during the first year: An fNIRS study. Early Hum Dev 2019; 133:23-28. [PMID: 31048133 DOI: 10.1016/j.earlhumdev.2019.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/06/2019] [Accepted: 04/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Motor impairments are frequently associated with preterm birth and interfere in acquisition of essential skills to global development. Using Near Infrared Spectroscopy (NIRS), the study of neural correlates of motor development in early stages of life are feasible in an ecological assessment. AIMS To evaluate changes in cortical activity in response to a sensorimotor stimulation in preterm and full-term infants at 6 and 12 months of age. STUDY DESIGN A longitudinal study was conducted with 22 infants (12 preterm and 10 full-term). Hemodynamic activity during sensorimotor task (8 blocks of 8 s of vibration applied to infant's right hand) was measured by Functional Near Infrared Spectroscopy (fNIRS). The optical probe consisted of 84 channels positioned according to the international 10-20 system coordinates, covering the frontal (38 channels), parietal (16 channels), temporal (22 channels) and occipital (8 channels) lobes of both hemispheres. RESULTS Preterm and full-term infants exhibited differences of location of the activation as well on the hemodynamic response in both the evaluated age groups. CONCLUSIONS Group differences in activation of sensorimotor cortex observed in this study demonstrate the potential of fNIRS application for preterm evaluation of motor development in children. Overall, the present work contributes to our understanding of cortical activation of cerebral motor skills spanning early ages in preterm-born children.
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Affiliation(s)
- Suelen Rosa de Oliveira
- School of Medicine, Department of Pediatrics, Federal University of Minas Gerais, MG, Brazil.
| | | | - Jonas Jardim de Paula
- School of Medicine, Department of Pediatrics, Federal University of Minas Gerais, MG, Brazil
| | - Sérgio Luiz Novi
- Institute of Physics, University of Campinas, Campinas, São Paulo, Brazil
| | - Rickson C Mesquita
- Institute of Physics, University of Campinas, Campinas, São Paulo, Brazil
| | | | - Maria Cândida F Bouzada
- School of Medicine, Department of Pediatrics, Federal University of Minas Gerais, MG, Brazil
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25
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Vasung L, Abaci Turk E, Ferradal SL, Sutin J, Stout JN, Ahtam B, Lin PY, Grant PE. Exploring early human brain development with structural and physiological neuroimaging. Neuroimage 2019; 187:226-254. [PMID: 30041061 PMCID: PMC6537870 DOI: 10.1016/j.neuroimage.2018.07.041] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/11/2022] Open
Abstract
Early brain development, from the embryonic period to infancy, is characterized by rapid structural and functional changes. These changes can be studied using structural and physiological neuroimaging methods. In order to optimally acquire and accurately interpret this data, concepts from adult neuroimaging cannot be directly transferred. Instead, one must have a basic understanding of fetal and neonatal structural and physiological brain development, and the important modulators of this process. Here, we first review the major developmental milestones of transient cerebral structures and structural connectivity (axonal connectivity) followed by a summary of the contributions from ex vivo and in vivo MRI. Next, we discuss the basic biology of neuronal circuitry development (synaptic connectivity, i.e. ensemble of direct chemical and electrical connections between neurons), physiology of neurovascular coupling, baseline metabolic needs of the fetus and the infant, and functional connectivity (defined as statistical dependence of low-frequency spontaneous fluctuations seen with functional magnetic resonance imaging (fMRI)). The complementary roles of magnetic resonance imaging (MRI), electroencephalography (EEG), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS) are discussed. We include a section on modulators of brain development where we focus on the placenta and emerging placental MRI approaches. In each section we discuss key technical limitations of the imaging modalities and some of the limitations arising due to the biology of the system. Although neuroimaging approaches have contributed significantly to our understanding of early brain development, there is much yet to be done and a dire need for technical innovations and scientific discoveries to realize the future potential of early fetal and infant interventions to avert long term disease.
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Affiliation(s)
- Lana Vasung
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Esra Abaci Turk
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Silvina L Ferradal
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jason Sutin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Jeffrey N Stout
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Banu Ahtam
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Pei-Yi Lin
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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26
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Effects of Prone Sleeping on Cerebral Oxygenation in Preterm Infants. J Pediatr 2019; 204:103-110.e1. [PMID: 30297295 DOI: 10.1016/j.jpeds.2018.08.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/04/2018] [Accepted: 08/29/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the effect of prone sleeping on cerebral oxygenation in preterm infants in the neonatal intensive care unit. STUDY DESIGN Preterm infants, divided into extremely preterm (gestational age 24-28 weeks; n = 23) and very preterm (gestational age 29-34 weeks; n = 33) groups, were studied weekly until discharge in prone and supine positions during active and quiet sleep. Cerebral tissue oxygenation index (TOI) and arterial oxygen saturation (SaO2) were recorded. Cerebral fractional tissue extraction (CFOE) was calculated as CFOE = (SaO2 - TOI)/SaO2. RESULTS In extremely preterm infants, CFOE increased modestly in the prone position in both sleep states at age 1 week, in no change in TOI despite higher SaO2. In contrast, the very preterm infants did not have position-related differences in CFOE until the fifth week of life. In the very preterm infants, TOI decreased and CFOE increased with active sleep compared with quiet sleep and with increasing postnatal age. CONCLUSION At 1 week of age, prone sleeping increased CFOE in extremely preterm infants, suggesting reduced cerebral blood flow. Our findings reveal important physiological insights in clinically stable preterm infants. Further studies are needed to verify our findings in unstable preterm infants regarding the potential risk of cerebral injury in the prone sleeping position in early postnatal life.
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27
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Morris EA, Juttukonda MR, Lee CA, Patel NJ, Pruthi S, Donahue MJ, Jordan LC. Elevated brain oxygen extraction fraction in preterm newborns with anemia measured using noninvasive MRI. J Perinatol 2018; 38:1636-1643. [PMID: 30254332 DOI: 10.1038/s41372-018-0229-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To test the hypothesis that cerebral oxygen extraction fraction (OEF) is elevated and inversely related to hematocrit level in anemic former very-low-birth-weight infants near term. STUDY DESIGN Prospective study of non-sedated preterm infants (post-menstrual age = 36 ± 2 weeks) over a range of hematocrits (0.23-0.49). Anatomical (T1-W, T2-W, and diffusion-weighted), cerebral blood flow (CBF), and OEF 3-T MRI were utilized. Statistical analysis included Spearman's rank-order correlation testing between study variables and intraclass correlation coefficients (ICC) calculated between consecutively acquired OEF scans. RESULTS Consecutive OEF measurements showed moderate-to-good agreement (ICC = 0.71; 95% CI = 0.40-0.87). OEF increased with worsening anemia (ρ = -0.58; p = 0.005), and OEF and basal ganglia CBF were positively correlated (ρ = 0.49; p = 0.023). CONCLUSION Noninvasive OEF MRI has moderate-to-good repeatability in non-sedated former preterm infants nearing term-equivalent age. Strong correlation of elevated OEF with anemia suggests hemodynamic compensation for anemia and could establish OEF as a useful biomarker of transfusion threshold for preterm infants.
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Affiliation(s)
- Emily A Morris
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Meher R Juttukonda
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea A Lee
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J Patel
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Physics and Astronomy, Vanderbilt University, Nashville, TN, USA
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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28
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Lynch JM, Gaynor JW, Licht DJ. Brain Injury During Transition in the Newborn With Congenital Heart Disease: Hazards of the Preoperative Period. Semin Pediatr Neurol 2018; 28:60-65. [PMID: 30522729 DOI: 10.1016/j.spen.2018.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infants born with critical congenital heart disease are at risk for neurodevelopmental morbidities later in life. In-utero differences in fetal circulation lead to vulnerabilities which lead to an increased incidence of stroke, white matter injury, and brain immaturity. Recent work has shown these infants may be most vulnerable to brain injury during the early neonatal period when they are awaiting their cardiac surgeries. Novel imaging and monitoring modalities are being employed to investigate this crucial time period and elucidate the precise timing and cause of brain injury in this population.
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Affiliation(s)
- Jennifer M Lynch
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel J Licht
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA
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29
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He L, Baker WB, Milej D, Kavuri VC, Mesquita RC, Busch DR, Abramson K, Jiang JY, Diop M, St. Lawrence K, Amendolia O, Quattrone F, Balu R, Kofke WA, Yodh AG. Noninvasive continuous optical monitoring of absolute cerebral blood flow in critically ill adults. NEUROPHOTONICS 2018; 5:045006. [PMID: 30480039 PMCID: PMC6251207 DOI: 10.1117/1.nph.5.4.045006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/29/2018] [Indexed: 05/18/2023]
Abstract
We investigate a scheme for noninvasive continuous monitoring of absolute cerebral blood flow (CBF) in adult human patients based on a combination of time-resolved dynamic contrast-enhanced near-infrared spectroscopy (DCE-NIRS) and diffuse correlation spectroscopy (DCS) with semi-infinite head model of photon propogation. Continuous CBF is obtained via calibration of the DCS blood flow index (BFI) with absolute CBF obtained by intermittent intravenous injections of the optical contrast agent indocyanine green. A calibration coefficient ( γ ) for the CBF is thus determined, permitting conversion of DCS BFI to absolute blood flow units at all other times. A study of patients with acute brain injury ( N = 7 ) is carried out to ascertain the stability of γ . The patient-averaged DCS calibration coefficient across multiple monitoring days and multiple patients was determined, and good agreement between the two calibration coefficients measured at different times during single monitoring days was found. The patient-averaged calibration coefficient of 1.24 × 10 9 ( mL / 100 g / min ) / ( cm 2 / s ) was applied to previously measured DCS BFI from similar brain-injured patients; in this case, absolute CBF was underestimated compared with XeCT, an effect we show is primarily due to use of semi-infinite homogeneous models of the head.
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Affiliation(s)
- Lian He
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
- Address all correspondence to: Lian He, E-mail:
| | - Wesley B. Baker
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Daniel Milej
- Western University, Department of Medical Biophysics, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Division, London, Ontario, Canada
| | - Venkaiah C. Kavuri
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | | | - David R. Busch
- University of Texas Southwestern, Department of Neurology and Neurotherapeutics, Dallas, Texas, United States
- University of Texas Southwestern, Department of Anesthesiology and Pain Management, Dallas, Texas, United States
| | - Kenneth Abramson
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Jane Y. Jiang
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
| | - Mamadou Diop
- Western University, Department of Medical Biophysics, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Division, London, Ontario, Canada
| | - Keith St. Lawrence
- Western University, Department of Medical Biophysics, London, Ontario, Canada
- Lawson Health Research Institute, Imaging Division, London, Ontario, Canada
| | - Olivia Amendolia
- University of Pennsylvania, Department of Neurosurgery, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Francis Quattrone
- University of Pennsylvania, Department of Neurosurgery, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Ramani Balu
- University of Pennsylvania, Department of Neurosurgery, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - W. Andrew Kofke
- University of Pennsylvania, Department of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Neurosurgery, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Arjun G. Yodh
- University of Pennsylvania, Department of Physics and Astronomy, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Department of Anesthesiology and Critical Care, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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30
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Lynch JM, Ko T, Busch DR, Newland JJ, Winters ME, Mensah-Brown K, Boorady TW, Xiao R, Nicolson SC, Montenegro LM, Gaynor JW, Spray TL, Yodh AG, Naim MY, Licht DJ. Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease. J Thorac Cardiovasc Surg 2018; 156:1657-1664. [PMID: 29859676 DOI: 10.1016/j.jtcvs.2018.04.098] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 04/19/2018] [Accepted: 04/24/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hypoxic-ischemic white matter brain injury commonly occurs in neonates with critical congenital heart disease. Recent work has shown that longer time to surgery is associated with increased risk for this injury. In this study we investigated changes in perinatal cerebral hemodynamics during the transition from fetal to neonatal circulation to ascertain mechanisms that might underlie this risk. METHODS Neonates with either transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS) were recruited for preoperative noninvasive optical monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using diffuse optical spectroscopy and diffuse correlation spectroscopy, 2 noninvasive optical techniques. Measurements were acquired daily from day of consent until the morning of surgery. Temporal trends in these measured parameters during the preoperative period were assessed with a mixed effects model. RESULTS Forty-eight neonates with TGA or HLHS were studied. Cerebral oxygen saturation was significantly and negatively correlated with time, and oxygen extraction fraction was significantly and positively correlated with time. Cerebral blood flow did not significantly change with time during the preoperative period. CONCLUSIONS In neonates with TGA or HLHS, increasing cerebral oxygen extraction combined with an abnormal cerebral blood flow response during the time between birth and heart surgery leads to a progressive decrease in cerebral tissue oxygenation The results support and help explain the physiological basis for recent studies that show longer time to surgery increases the risk of acquiring white matter injury.
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Affiliation(s)
- Jennifer M Lynch
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Penn.
| | - Tiffany Ko
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pa; Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa
| | - David R Busch
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa; Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - John J Newland
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Madeline E Winters
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Kobina Mensah-Brown
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Timothy W Boorady
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pa
| | - Susan C Nicolson
- Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Lisa M Montenegro
- Division of Cardiothoracic Anesthesia, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - J William Gaynor
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Thomas L Spray
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Arjun G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pa
| | - Maryam Y Naim
- Division of Cardiac Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Daniel J Licht
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pa
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31
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Beausoleil TP, Janaillac M, Barrington KJ, Lapointe A, Dehaes M. Cerebral oxygen saturation and peripheral perfusion in the extremely premature infant with intraventricular and/or pulmonary haemorrhage early in life. Sci Rep 2018; 8:6511. [PMID: 29695729 PMCID: PMC5916916 DOI: 10.1038/s41598-018-24836-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/09/2018] [Indexed: 12/29/2022] Open
Abstract
Extremely preterm infants are at higher risk of pulmonary (PH) and intraventricular (IVH) haemorrhage during the transitioning physiology due to immature cardiovascular system. Monitoring of haemodynamics can detect early abnormal circulation that may lead to these complications. We described time-frequency relationships between near infrared spectroscopy (NIRS) cerebral regional haemoglobin oxygen saturation (CrSO2) and preductal peripheral perfusion index (PI), capillary oxygen saturation (SpO2) and heart rate (HR) in extremely preterm infants in the first 72 h of life. Patients were sub-grouped in infants with PH and/or IVH (N H = 8) and healthy controls (N C = 11). Data were decomposed in wavelets allowing the analysis of localized variations of power. This approach allowed to quantify the percentage of time of significant cross-correlation, semblance, gain (transfer function) and coherence between signals. Ultra-low frequencies (<0.28 mHz) were analyzed as slow and prolonged periods of impaired circulation are considered more detrimental than transient fluctuations. Cross-correlation between CrSO2 and oximetry (PI, SpO2 and HR) as well as in-phase semblance and gain between CrSO2 and HR were significantly lower while anti-phase semblance between CrSO2 and HR was significantly higher in PH-IVH infants compared to controls. These differences may reflect haemodynamic instability associated with cerebrovascular autoregulation and hemorrhagic complications observed during the transitioning physiology.
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Affiliation(s)
- Thierry P Beausoleil
- Institute of Biomedical Engineering, University of Montréal, Montréal, Canada.,Research Centre, CHU Sainte-Justine, Montréal, Canada
| | - Marie Janaillac
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Keith J Barrington
- Research Centre, CHU Sainte-Justine, Montréal, Canada.,Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Anie Lapointe
- Department of Pediatrics, Division of Neonatology, CHU Sainte-Justine and University of Montréal, Montréal, Canada
| | - Mathieu Dehaes
- Research Centre, CHU Sainte-Justine, Montréal, Canada. .,Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montréal, Montréal, Canada.
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32
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Correlations between near-infrared spectroscopy, perfusion index, and cardiac outputs in extremely preterm infants in the first 72 h of life. Eur J Pediatr 2018; 177:541-550. [PMID: 29374830 DOI: 10.1007/s00431-018-3096-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/14/2017] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Haemodynamic assessment during the transitional period in preterm infants is challenging. We aimed to describe the relationships between cerebral regional tissue oxygen saturation (CrSO2), perfusion index (PI), echocardiographic, and clinical parameters in extremely preterm infants in their first 72 h of life. Twenty newborns born at < 28 weeks of gestation were continuously monitored with CrSO2 and preductal PI. Cardiac output was measured at H6, H24, H48, and H72. The median gestational age and birth weight were 25.0 weeks (24-26) and 750 g (655-920), respectively. CrSO2 and preductal PI had r values < 0.35 with blood gases, lactates, haemoglobin, and mean blood pressure. Cardiac output significantly increased over the 72 h of the study period. Fifteen patients had at least one episode of low left and/or right ventricular output (RVO), during which there was a strong correlation between CrSO2 and superior vena cava (SVC) flow (at H6 (r = 0.74) and H24 (r = 0.86)) and between PI and RVO (at H6 (r = 0.68) and H24 (r = 0.92)). Five patients had low SVC flow (≤ 40 mL/kg/min) at H6, during which PI was strongly correlated with RVO (r = 0.98). CONCLUSION CrSO2 and preductal PI are strongly correlated with cardiac output during low cardiac output states. What is Known: • Perfusion index and near-infrared spectroscopy are non-invasive tools to evaluate haemodynamics in preterm infants. • Pre- and postductal perfusion indexes strongly correlate with left ventricular output in term infants, and near-infrared spectroscopy has been validated to assess cerebral oxygenation in term and preterm infants. What is New: • Cerebral regional tissue oxygen saturation and preductal perfusion index were strongly correlated with cardiac output during low cardiac output states. • The strength of the correlation between cerebral regional tissue oxygen saturation, preductal perfusion index, and cardiac output varied in the first 72 h of life, reflecting the complexity of the transitional physiology.
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33
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Farzam P, Buckley EM, Lin PY, Hagan K, Grant PE, Inder TE, Carp SA, Franceschini MA. Shedding light on the neonatal brain: probing cerebral hemodynamics by diffuse optical spectroscopic methods. Sci Rep 2017; 7:15786. [PMID: 29150648 PMCID: PMC5693925 DOI: 10.1038/s41598-017-15995-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
Investigating the cerebral physiology of healthy term newborns' brains is important for better understanding perinatal brain injuries, of which the most common etiologies are hypoxia and ischemia. Hence, cerebral blood flow and cerebral oxygenation are important biomarkers of brain health. In this study, we employed a hybrid diffuse optical system consisting of diffuse correlation spectroscopy (DCS) and frequency-domain near infrared spectroscopy (FDNIRS) to measure hemoglobin concentration, oxygen saturation, and indices of cerebral blood flow and metabolism. We measured 30 term infants to assess the optical and physiological characteristics of the healthy neonatal brain in the frontal, temporal, and parietal lobes. We observed higher metabolism in the right hemisphere compared to the left and a positive correlation between gestational age and the level of cerebral hemoglobin concentration, blood volume, and oxygen saturation. Moreover, we observed higher cerebral blood flow and lower oxygen saturation in females compared to males. The delayed maturation in males and the sexual dimorphism in cerebral hemodynamics may explain why males are more vulnerable to perinatal brain injuries than females.
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Affiliation(s)
- Parisa Farzam
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA.
| | - Erin M Buckley
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
- Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Pei-Yi Lin
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
| | - Katherine Hagan
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
| | - P Ellen Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center, Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Terrie Eleanor Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Stefan A Carp
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
| | - Maria Angela Franceschini
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02129, USA
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34
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Shedding light on the neonatal brain: probing cerebral hemodynamics by diffuse optical spectroscopic methods. Sci Rep 2017. [PMID: 29150648 DOI: 10.1038/s41598‐017‐15995‐1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Investigating the cerebral physiology of healthy term newborns' brains is important for better understanding perinatal brain injuries, of which the most common etiologies are hypoxia and ischemia. Hence, cerebral blood flow and cerebral oxygenation are important biomarkers of brain health. In this study, we employed a hybrid diffuse optical system consisting of diffuse correlation spectroscopy (DCS) and frequency-domain near infrared spectroscopy (FDNIRS) to measure hemoglobin concentration, oxygen saturation, and indices of cerebral blood flow and metabolism. We measured 30 term infants to assess the optical and physiological characteristics of the healthy neonatal brain in the frontal, temporal, and parietal lobes. We observed higher metabolism in the right hemisphere compared to the left and a positive correlation between gestational age and the level of cerebral hemoglobin concentration, blood volume, and oxygen saturation. Moreover, we observed higher cerebral blood flow and lower oxygen saturation in females compared to males. The delayed maturation in males and the sexual dimorphism in cerebral hemodynamics may explain why males are more vulnerable to perinatal brain injuries than females.
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35
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Roberts SB, Franceschini MA, Krauss A, Lin PY, Braima de Sa A, Có R, Taylor S, Brown C, Chen O, Johnson EJ, Pruzensky W, Schlossman N, Balé C, Wu KC(T, Hagan K, Saltzman E, Muentener P. A Pilot Randomized Controlled Trial of a New Supplementary Food Designed to Enhance Cognitive Performance during Prevention and Treatment of Malnutrition in Childhood. Curr Dev Nutr 2017; 1:e000885. [PMID: 29658962 PMCID: PMC5898396 DOI: 10.3945/cdn.117.000885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/11/2017] [Accepted: 10/12/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cognitive impairment associated with childhood malnutrition and stunting is generally considered irreversible. OBJECTIVE The aim was to test a new nutritional supplement for the prevention and treatment of moderate-acute malnutrition (MAM) focused on enhancing cognitive performance. METHODS An 11-wk, village-randomized, controlled pilot trial was conducted in 78 children aged 1-3 or 5-7 y living in villages in Guinea-Bissau. The supplement contained 291 kcal/d for young children and 350 kcal/d for older children and included 5 nutrients and 2 flavan-3-ol-rich ingredients not present in current food-based recommendations for MAM. Local bakers prepared the supplement from a combination of locally sourced items and an imported mix of ingredients, and it was administered by community health workers 5 d/wk. The primary outcome was executive function abilities at 11 wk. Secondary outcomes included additional cognitive measures and changes in z scores for weight (weight-for-age) and height (height-for-age) and hemoglobin concentrations at 11 wk. An index of cerebral blood flow (CBF) was also measured at 11 wk to explore the use of this measurement as a biological index of cognitive impairment. RESULTS There were no significant differences in any outcome between groups at baseline. There was a beneficial effect of random assignment to the supplement group on working memory at 11 wk in children aged 1-3 y (P < 0.05). This difference contrasted with no effect in older children and was not associated with faster growth rate. In addition, CBF correlated with task-switching performance (P < 0.05). CONCLUSIONS These preliminary data suggest that cognitive impairment can be monitored with measurement of CBF. In addition, the findings provide preliminary data that suggest that it may be possible to improve poor cognitive performance in young children through changes in the nutritional formulation of supplementary foods used to prevent and treat MAM. Powered studies of the new supplement formulation are needed. This trial was registered at clinicaltrials.gov as NCT03017209.
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Affiliation(s)
- Susan B Roberts
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Amy Krauss
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Pei-Yi Lin
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Augusto Braima de Sa
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Raimundo Có
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Salima Taylor
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Carrie Brown
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
| | - Oliver Chen
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Elizabeth J Johnson
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - William Pruzensky
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | | | - Carlito Balé
- International Partnership for Human Development, Leesburg, VA
- International Partnership for Human Development, Bissau, Guinea-Bissau
| | - Kuan-Cheng (Tony) Wu
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Katherine Hagan
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA
| | - Edward Saltzman
- USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Spinelli L, Zucchelli L, Contini D, Caffini M, Mehler J, Fló A, Ferry AL, Filippin L, Macagno F, Cattarossi L, Torricelli A. In vivo measure of neonate brain optical properties and hemodynamic parameters by time-domain near-infrared spectroscopy. NEUROPHOTONICS 2017; 4:041414. [PMID: 28840165 PMCID: PMC5561670 DOI: 10.1117/1.nph.4.4.041414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/11/2017] [Indexed: 05/20/2023]
Abstract
By exploiting a multichannel portable instrument for time-domain near-infrared spectroscopy (TD-NIRS), we characterized healthy neonates' brains in term of optical properties and hemodynamic parameters. In particular, we assessed the absolute values of the absorption and reduced scattering coefficients at two wavelengths, together with oxy-, deoxy- and total hemoglobin concentrations, and the blood oxygen saturation of the neonates' brains. In this study, 33 healthy full-term neonates were tested, obtaining the following median values: 0.28 and [Formula: see text] for [Formula: see text] at 690 and 820 nm, respectively; 5.8 and [Formula: see text] for [Formula: see text] at 690 and 820 nm, respectively; [Formula: see text] for [Formula: see text]; [Formula: see text] for [Formula: see text]; [Formula: see text] for [Formula: see text]; 72% for [Formula: see text]. In general, the agreement of these values with the sparse existing literature appears not always consistent. These findings demonstrate the first measurements of optical properties of the healthy neonate brain using TD-NIRS and show the need for clarification of optical properties across methods and populations.
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Affiliation(s)
- Lorenzo Spinelli
- CNR, Istituto di Fotonica e Nanotecnologie, Milano, Italy
- Address all correspondence to: Lorenzo Spinelli, E-mail:
| | - Lucia Zucchelli
- Politecnico di Milano, Dipartimento di Fisica, Milano, Italy
| | - Davide Contini
- Politecnico di Milano, Dipartimento di Fisica, Milano, Italy
| | - Matteo Caffini
- Politecnico di Milano, Dipartimento di Fisica, Milano, Italy
| | - Jacques Mehler
- SISSA, Language, Cognition, and Development Laboratory, Trieste, Italy
| | - Ana Fló
- SISSA, Language, Cognition, and Development Laboratory, Trieste, Italy
| | - Alissa L. Ferry
- SISSA, Language, Cognition, and Development Laboratory, Trieste, Italy
| | - Luca Filippin
- SISSA, Language, Cognition, and Development Laboratory, Trieste, Italy
- CNRS-EHESS-ENS, Laboratoire de Sciences Cognitives et Psycholinguistique, Paris, France
| | - Francesco Macagno
- Presidio Ospedaliero Universitario “Santa Maria della Misericordia,” Neonatology Unit, Udine, Italy
| | - Luigi Cattarossi
- Presidio Ospedaliero Universitario “Santa Maria della Misericordia,” Neonatology Unit, Udine, Italy
| | - Alessandro Torricelli
- CNR, Istituto di Fotonica e Nanotecnologie, Milano, Italy
- Politecnico di Milano, Dipartimento di Fisica, Milano, Italy
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37
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Ghosh A, Highton D, Kolyva C, Tachtsidis I, Elwell CE, Smith M. Hyperoxia results in increased aerobic metabolism following acute brain injury. J Cereb Blood Flow Metab 2017; 37:2910-2920. [PMID: 27837190 PMCID: PMC5536254 DOI: 10.1177/0271678x16679171] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Acute brain injury is associated with depressed aerobic metabolism. Below a critical mitochondrial pO2 cytochrome c oxidase, the terminal electron acceptor in the mitochondrial respiratory chain, fails to sustain oxidative phosphorylation. After acute brain injury, this ischaemic threshold might be shifted into apparently normal levels of tissue oxygenation. We investigated the oxygen dependency of aerobic metabolism in 16 acutely brain-injured patients using a 120-min normobaric hyperoxia challenge in the acute phase (24-72 h) post-injury and multimodal neuromonitoring, including transcranial Doppler ultrasound-measured cerebral blood flow velocity, cerebral microdialysis-derived lactate-pyruvate ratio (LPR), brain tissue pO2 (pbrO2), and tissue oxygenation index and cytochrome c oxidase oxidation state (oxCCO) measured using broadband spectroscopy. Increased inspired oxygen resulted in increased pbrO2 [ΔpbrO2 30.9 mmHg p < 0.001], reduced LPR [ΔLPR -3.07 p = 0.015], and increased cytochrome c oxidase (CCO) oxidation (Δ[oxCCO] + 0.32 µM p < 0.001) which persisted on return-to-baseline (Δ[oxCCO] + 0.22 µM, p < 0.01), accompanied by a 7.5% increase in estimated cerebral metabolic rate for oxygen ( p = 0.038). Our results are consistent with an improvement in cellular redox state, suggesting oxygen-limited metabolism above recognised ischaemic pbrO2 thresholds. Diffusion limitation or mitochondrial inhibition might explain these findings. Further investigation is warranted to establish optimal oxygenation to sustain aerobic metabolism after acute brain injury.
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Affiliation(s)
- Arnab Ghosh
- 1 Neurocritical Care, University College London Hospitals, National Hospital for Neurology & Neurosurgery, London, UK
| | - David Highton
- 1 Neurocritical Care, University College London Hospitals, National Hospital for Neurology & Neurosurgery, London, UK
| | - Christina Kolyva
- 2 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Ilias Tachtsidis
- 2 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Clare E Elwell
- 2 Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Martin Smith
- 1 Neurocritical Care, University College London Hospitals, National Hospital for Neurology & Neurosurgery, London, UK.,2 Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,3 University College London Hospitals National Institute for Health Research Biomedical Research Centre, London, UK
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38
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Gumulak R, Lucanova LC, Zibolen M. Use of near-infrared spectroscopy (NIRS) in cerebral tissue oxygenation monitoring in neonates. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:128-133. [DOI: 10.5507/bp.2017.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/20/2017] [Indexed: 11/23/2022] Open
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Watanabe H, Shitara Y, Aoki Y, Inoue T, Tsuchida S, Takahashi N, Taga G. Hemoglobin phase of oxygenation and deoxygenation in early brain development measured using fNIRS. Proc Natl Acad Sci U S A 2017; 114:E1737-E1744. [PMID: 28196885 PMCID: PMC5338505 DOI: 10.1073/pnas.1616866114] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A crucial issue in neonatal medicine is the impact of preterm birth on the developmental trajectory of the brain. Although a growing number of studies have shown alterations in the structure and function of the brain in preterm-born infants, we propose a method to detect subtle differences in neurovascular and metabolic functions in neonates and infants. Functional near-infrared spectroscopy (fNIRS) was used to obtain time-averaged phase differences between spontaneous low-frequency (less than 0.1 Hz) oscillatory changes in oxygenated hemoglobin (oxy-Hb) and those in deoxygenated hemoglobin (deoxy-Hb). This phase difference was referred to as hemoglobin phase of oxygenation and deoxygenation (hPod) in the cerebral tissue of sleeping neonates and infants. We examined hPod in term, late preterm, and early preterm infants with no evidence of clinical issues and found that all groups of infants showed developmental changes in the values of hPod from an in-phase to an antiphase pattern. Comparison of hPod among the groups revealed that developmental changes in hPod in early preterm infants precede those in late preterm and term infants at term equivalent age but then, progress at a slower pace. This study suggests that hPod measured using fNIRS is sensitive to the developmental stage of the integration of circular, neurovascular, and metabolic functions in the brains of neonates and infants.
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Affiliation(s)
- Hama Watanabe
- Graduate School of Education, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Yoshihiko Shitara
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Yoshinori Aoki
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Takanobu Inoue
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Shinya Tsuchida
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Naoto Takahashi
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Gentaro Taga
- Graduate School of Education, The University of Tokyo, Tokyo 113-0033, Japan
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40
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Diaz D, Lafontant A, Neidrauer M, Weingarten MS, DiMaria-Ghalili RA, Scruggs E, Rece J, Fried GW, Kuzmin VL, Zubkov L. Pressure injury prediction using diffusely scattered light. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:25003. [PMID: 28301656 DOI: 10.1117/1.jbo.22.2.025003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
Pressure injuries (PIs) originate beneath the surface of the skin at the interface between bone and soft tissue. We used diffuse correlation spectroscopy (DCS) and diffuse near-infrared spectroscopy (DNIRS) to predict the development of PIs by measuring dermal and subcutaneous red cell motion and optical absorption and scattering properties in 11 spinal cord injury subjects with only nonbleachable redness in the sacrococcygeal area in a rehabilitation hospital and 20 healthy volunteers. A custom optical probe was developed to obtain continuous DCS and DNIRS data from sacrococcygeal tissue while the subjects were placed in supine and lateral positions to apply pressure from body weight and to release pressure, respectively. Rehabilitation patients were measured up to four times over a two-week period. Three rehabilitation patients developed open PIs (POs) within four weeks and eight patients did not (PNOs). Temporal correlation functions in the area of redness were significantly different ( p < 0.01 ) during both baseline and applied pressure stages for POs and PNOs. The results show that our optical method may be used for the early prediction of ulcer progression.
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Affiliation(s)
- David Diaz
- Drexel University, School of Biomedical Engineering, Philadelphia, Pennsylvania, United States
| | - Alec Lafontant
- Drexel University, School of Biomedical Engineering, Philadelphia, Pennsylvania, United States
| | - Michael Neidrauer
- Drexel University, School of Biomedical Engineering, Philadelphia, Pennsylvania, United States
| | - Michael S Weingarten
- Drexel University, College of Medicine, Department of Surgery, Philadelphia, Pennsylvania, United States
| | - Rose Ann DiMaria-Ghalili
- Drexel University, College of Nursing and Health Professions, Philadelphia, Pennsylvania, United States
| | - Ericka Scruggs
- Magee Rehabilitation Hospital, Philadelphia, Pennsylvania, United States
| | - Julianne Rece
- Magee Rehabilitation Hospital, Philadelphia, Pennsylvania, United States
| | - Guy W Fried
- Magee Rehabilitation Hospital, Philadelphia, Pennsylvania, United States
| | | | - Leonid Zubkov
- Drexel University, School of Biomedical Engineering, Philadelphia, Pennsylvania, United States
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41
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Dix L, Molenschot M, Breur J, de Vries W, Vijlbrief D, Groenendaal F, van Bel F, Lemmers P. Cerebral oxygenation and echocardiographic parameters in preterm neonates with a patent ductus arteriosus: an observational study. Arch Dis Child Fetal Neonatal Ed 2016; 101:F520-F526. [PMID: 27034323 DOI: 10.1136/archdischild-2015-309192] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 02/15/2016] [Accepted: 03/03/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND A haemodynamically significant patent ductus arteriosus (hsPDA) is clinically suspected and confirmed by echocardiographic examination. A hsPDA decreases cerebral blood flow and oxygen saturation by the ductal steal phenomenon. AIM To determine the relationship between echocardiographic parameters, cerebral oxygenation and a hsPDA in preterm infants. METHODS 380 preterm infants (<32 weeks gestational age) born between 2008 and 2010 were included. Blinded echocardiographic examination was performed on the second, fourth and sixth day after birth. Examinations were deblinded when hsPDA was clinically suspected. Regional cerebral oxygen saturation (rScO2) was continuously monitored by near-infrared spectroscopy during 72 h after birth, and afterwards for at least 1 h before echocardiography. Echocardiographic parameters included ductal diameter, end-diastolic flow in the left pulmonary artery, left atrium/aorta ratio and ductal flow pattern. RESULTS rScO2 was significantly related only to ductal diameter over time. Mixed modelling analysed the course of rScO2 over time, where infants were divided into four groups: a closed duct, an open haemodynamically insignificant duct (non-sPDA), a hsPDA, which was successfully closed during study period (SC hsPDA) or a hsPDA, which was unsuccessfully closed during study period (UC hsPDA). SC hsPDA infants showed the highest rScO2 on day 6, while UC hsPDA infants had the lowest rScO2 values. CONCLUSIONS Ductal diameter is the only echocardiographic parameter significantly related to cerebral oxygenation over time. Cerebral oxygenation takes a different course over time depending on the status of the duct. Low cerebral oxygenation may be suggestive of a hsPDA.
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Affiliation(s)
- Laura Dix
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Mirella Molenschot
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Johannes Breur
- Department of Paediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Willem de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Daniel Vijlbrief
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Petra Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
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42
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Galderisi A, Brigadoi S, Cutini S, Moro SB, Lolli E, Meconi F, Benavides-Varela S, Baraldi E, Amodio P, Cobelli C, Trevisanuto D, Dell’Acqua R. Long-term continuous monitoring of the preterm brain with diffuse optical tomography and electroencephalography: a technical note on cap manufacturing. NEUROPHOTONICS 2016; 3:045009. [PMID: 28042587 PMCID: PMC5180615 DOI: 10.1117/1.nph.3.4.045009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/29/2016] [Indexed: 06/06/2023]
Abstract
Diffuse optical tomography (DOT) has recently proved useful for detecting whole-brain oxygenation changes in preterm and term newborns' brains. The data recording phase in prior explorations was limited up to a maximum of a couple of hours, a time dictated by the need to minimize skin damage caused by the protracted contact with optode holders and interference with concomitant clinical/nursing procedures. In an attempt to extend the data recording phase, we developed a new custom-made cap for multimodal DOT and electroencephalography acquisitions for the neonatal population. The cap was tested on a preterm neonate (28 weeks gestation) for a 7-day continuous monitoring period. The cap was well tolerated by the neonate, who did not suffer any evident discomfort and/or skin damage. Montage and data acquisition using our cap was operated by an attending nurse with no difficulty. DOT data quality was remarkable, with an average of 92% of reliable channels, characterized by the clear presence of the heartbeat in most of them.
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Affiliation(s)
- Alfonso Galderisi
- University of Padova, Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, via Giustiniani 3, 35128 Padova, Italy
| | - Sabrina Brigadoi
- University of Padova, Department of Developmental Psychology, via Venezia 8, 35131 Padova, Italy
| | - Simone Cutini
- University of Padova, Department of Developmental Psychology, via Venezia 8, 35131 Padova, Italy
- University of Padova, Padua Neuroscience Center, via Venezia 8, 35131 Padova, Italy
| | - Sara Basso Moro
- University of Padova, Department of Neuroscience, via Giustiniani 2, 35128 Padova, Italy
| | - Elisabetta Lolli
- University of Padova, Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, via Giustiniani 3, 35128 Padova, Italy
| | - Federica Meconi
- University of Padova, Department of Developmental Psychology, via Venezia 8, 35131 Padova, Italy
| | - Silvia Benavides-Varela
- University of Padova, Department of Developmental Psychology, via Venezia 8, 35131 Padova, Italy
| | - Eugenio Baraldi
- University of Padova, Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, via Giustiniani 3, 35128 Padova, Italy
| | - Piero Amodio
- University of Padova, Department of Medicine, via Giustiniani 2, 35128 Padova, Italy
| | - Claudio Cobelli
- University of Padova, Department of Information Engineering, via Gradenigo 6/b, 35131 Padova, Italy
| | - Daniele Trevisanuto
- University of Padova, Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, via Giustiniani 3, 35128 Padova, Italy
| | - Roberto Dell’Acqua
- University of Padova, Department of Developmental Psychology, via Venezia 8, 35131 Padova, Italy
- University of Padova, Padua Neuroscience Center, via Venezia 8, 35131 Padova, Italy
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Verdecchia K, Diop M, Lee A, Morrison LB, Lee TY, St. Lawrence K. Assessment of a multi-layered diffuse correlation spectroscopy method for monitoring cerebral blood flow in adults. BIOMEDICAL OPTICS EXPRESS 2016; 7:3659-3674. [PMID: 27699127 PMCID: PMC5030039 DOI: 10.1364/boe.7.003659] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 05/21/2023]
Abstract
Diffuse correlation spectroscopy (DCS) is a promising technique for brain monitoring as it can provide a continuous signal that is directly related to cerebral blood flow (CBF); however, signal contamination from extracerebral tissue can cause flow underestimations. The goal of this study was to investigate whether a multi-layered (ML) model that accounts for light propagation through the different tissue layers could successfully separate scalp and brain flow when applied to DCS data acquired at multiple source-detector distances. The method was first validated with phantom experiments. Next, experiments were conducted in a pig model of the adult head with a mean extracerebral tissue thickness of 9.8 ± 0.4 mm. Reductions in CBF were measured by ML DCS and computed tomography perfusion for validation; excellent agreement was observed by a mean difference of 1.2 ± 4.6% (CI95%: -31.1 and 28.6) between the two modalities, which was not significantly different.
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Affiliation(s)
- Kyle Verdecchia
- Imaging Program, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
- Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
- Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Albert Lee
- Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Laura B. Morrison
- Imaging Program, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
- Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Ting-Yim Lee
- Imaging Program, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
- Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 3K7, Canada
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6G 2V4, Canada
| | - Keith St. Lawrence
- Imaging Program, Lawson Health Research Institute, London, Ontario N6A 4V2, Canada
- Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 3K7, Canada
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Reduced cerebral blood flow and oxygen metabolism in extremely preterm neonates with low-grade germinal matrix- intraventricular hemorrhage. Sci Rep 2016; 6:25903. [PMID: 27181339 PMCID: PMC4867629 DOI: 10.1038/srep25903] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/25/2016] [Indexed: 01/24/2023] Open
Abstract
Low-grade germinal matrix-intraventricular hemorrhage (GM-IVH) is the most common complication in extremely premature neonates. The occurrence of GM-IVH is highly associated with hemodynamic instability in the premature brain, yet the long-term impact of low-grade GM-IVH on cerebral blood flow and neuronal health have not been fully investigated. We used an innovative combination of frequency-domain near infrared spectroscopy and diffuse correlation spectroscopy (FDNIRS-DCS) to measure cerebral oxygen saturation (SO2) and an index of cerebral blood flow (CBFi) at the infant’s bedside and compute an index of cerebral oxygen metabolism (CMRO2i). We enrolled twenty extremely low gestational age (ELGA) neonates (seven with low-grade GM-IVH) and monitored them weekly until they reached full-term equivalent age. During their hospital stay, we observed consistently lower CBFi and CMRO2i in ELGA neonates with low-grade GM-IVH compared to neonates without hemorrhages. Furthermore, lower CBFi and CMRO2i in the former group persists even after the resolution of the hemorrhage. In contrast, SO2 does not differ between groups. Thus, CBFi and CMRO2i may have better sensitivity than SO2 in detecting GM-IVH-related effects on infant brain development. FDNIRS-DCS methods may have clinical benefit for monitoring the evolution of GM-IVH, evaluating treatment response, and potentially predicting neurodevelopmental outcome.
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Conforti A, Giliberti P, Landolfo F, Valfrè L, Columbo C, Mondi V, Capolupo I, Dotta A, Bagolan P. Effects of ventilation modalities on near-infrared spectroscopy in surgically corrected CDH infants. J Pediatr Surg 2016; 51:349-53. [PMID: 26342630 DOI: 10.1016/j.jpedsurg.2015.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 07/25/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) is a noninvasive technique for monitoring tissue oxygenation and perfusion. The aim of this study was to evaluate cerebral and splanchnic NIRS changes in CDH operated infants enrolled into the VICI trial and therefore randomized for ventilatory modalities. MATERIALS AND METHODS CDH newborns enrolled into the VICI trial (Netherlands Trial Register, NTR 1310) were randomized at birth for high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CMV) according to the trial. Cerebral oxygenation (rSO2C) and splanchnic oxygenation (rSO2S) were obtained by NIRS (INVOS 5100; Somanetics, Troy, MI) before and after surgery. Variations in rSO2C and rSO2S were evaluated. Mann-Whitney test and one-way ANOVA were used as appropriate. p<0.05 was considered significant. RESULTS Thirteen VICI trial patients underwent surgical repair between March 2011 and December 2012, and were enrolled in the study. Seven patients were assigned to HFOV and six to CMV group respectively. During surgery, a significant reduction in rSO2C (p=0.0001) and rSO2S (p=0.005) were observed. HFOV patients experienced prolonged reduction in rSO2C value (p=0.003) while rSO2S did not vary between HFOV and CMV (p=0.94). CONCLUSIONS Surgical CDH repair was associated with decrease of cerebral and splanchnic oxygenation, regardless of ventilation. Patients ventilated by HFOV need a longer time interval to recovery normal rSO2C values, than those ventilated by CMV. This may be owing to a different impact of HFOV on patients' hemodynamic status with a higher impairment on total venous return and its negative consequences on cardiac output.
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Affiliation(s)
- Andrea Conforti
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
| | - Paola Giliberti
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Landolfo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Laura Valfrè
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Claudia Columbo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Vito Mondi
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Irma Capolupo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Dotta
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
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Alderliesten T, Dix L, Baerts W, Caicedo A, van Huffel S, Naulaers G, Groenendaal F, van Bel F, Lemmers P. Reference values of regional cerebral oxygen saturation during the first 3 days of life in preterm neonates. Pediatr Res 2016; 79:55-64. [PMID: 26389823 DOI: 10.1038/pr.2015.186] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Currently, reliable reference values of regional cerebral oxygen saturation (rScO2) for different gestational age (GA) groups are lacking, which hampers the implementation of near-infrared spectroscopy (NIRS) alongside monitoring arterial oxygen saturation (SaO2) and blood pressure in neonatal intensive care. The aim of this study was to provide reference values for rScO2 and cerebral fractional tissue oxygen extraction (cFTOE; (SaO2 - rScO2)/SaO2) for small adult and neonatal NIRS sensors. METHODS In this study, 999 infants born preterm (GA <32 wk) were monitored with NIRS during the first 72 h of life. Mixed modeling was used to generate reference curves grouped per 2 wk of GA. In addition, the influence of a hemodynamically significant patent ductus arteriosus, gender, and birth weight were explored. RESULTS Average rScO2 was ~65% at admission, increased with GA (1% per week) and followed a parabolic curve in relation to postnatal age with a peak at ~36 h. The cFTOE showed similar but inverse effects. On average, the neonatal sensor measured 10% higher than the adult sensor. CONCLUSION rScO2 and cFTOE reference curves are provided for the first 72 h of life in preterm infants, which might support the broader implementation of NIRS in neonatal intensive care.
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Affiliation(s)
- Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura Dix
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim Baerts
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander Caicedo
- Department of Electrical Engineering (ESAT), Division SCD, KU Leuven, Leuven, Belgium.,iMinds-KU Leuven Future Health Department, Leuven, Belgium
| | - Sabine van Huffel
- Department of Electrical Engineering (ESAT), Division SCD, KU Leuven, Leuven, Belgium.,iMinds-KU Leuven Future Health Department, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital The Gasthuisberg, Leuven, Belgium
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank van Bel
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra Lemmers
- Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
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Govindan RB, Massaro A, Chang T, Vezina G, du Plessis A. A novel technique for quantitative bedside monitoring of neurovascular coupling. J Neurosci Methods 2015; 259:135-142. [PMID: 26684362 DOI: 10.1016/j.jneumeth.2015.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 11/24/2015] [Accepted: 11/27/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is no current method for continuous quantification of neurovascular coupling (NVC) in spontaneous brain activity. To fill this void, we propose a novel method to quantify NVC using electroencephalogram (EEG) and near-infrared spectroscopy (NIRS) data. NEW METHOD Since EEG and NIRS measure physiologic changes occurring at different time scales, we bring them into a common dynamical time frame (DTF). To achieve this, we partition both signals into one-second epochs and calculate the standard deviation of the EEG and the average value of the NIRS for each epoch. We then quantify the NVC by calculating spectral coherence between the two signals in the DTF. The resulting NVC will have a low resolution with all of its content localized below 1Hz. RESULTS After validating this framework on simulated data, we applied this approach to EEG and NIRS signals collected from four term infants undergoing therapeutic hypothermia for neonatal encephalopathy. Two of these infants showed no evidence of structural brain injury, and the other two died during the course of the therapy. The intact survivors showed emergence of NVC during hypothermia and/or after rewarming. In contrast, the two critically ill infants, who subsequently died, lacked this feature. COMPARISON WITH EXISTING METHODS Existing methods quantify NVC by averaging neurovascular signals based on certain events (for example seizure) in the EEG activity, whereas our approach quantifies coupling between spontaneous background EEG and NIRS. CONCLUSION Real-time continuous monitoring of NVC may be a promising physiologic signal for cerebral monitoring in future.
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Affiliation(s)
- R B Govindan
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010, USA.
| | - An Massaro
- Division of Neonatology, Children's National, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Taeun Chang
- Division of Neurology, Children's National, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Gilbert Vezina
- Division of Diagnostic Imaging and Radiology, Children's National, 111 Michigan Ave NW, Washington, DC 20010, USA
| | - Adré du Plessis
- Division of Fetal and Transitional Medicine, Fetal Medicine Institute, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010, USA
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Dehaes M, Cheng HH, Buckley EM, Lin PY, Ferradal S, Williams K, Vyas R, Hagan K, Wigmore D, McDavitt E, Soul JS, Franceschini MA, Newburger JW, Ellen Grant P. Perioperative cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle physiology. BIOMEDICAL OPTICS EXPRESS 2015; 6:4749-67. [PMID: 26713191 PMCID: PMC4679251 DOI: 10.1364/boe.6.004749] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/01/2015] [Accepted: 11/03/2015] [Indexed: 05/03/2023]
Abstract
Congenital heart disease (CHD) patients are at risk for neurodevelopmental delay. The etiology of these delays is unclear, but abnormal prenatal cerebral maturation and postoperative hemodynamic instability likely play a role. A better understanding of these factors is needed to improve neurodevelopmental outcome. In this study, we used bedside frequency-domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) to assess cerebral hemodynamics and oxygen metabolism in neonates with single-ventricle (SV) CHD undergoing surgery and compared them to controls. Our goals were 1) to compare cerebral hemodynamics between unanesthetized SV and healthy neonates, and 2) to determine if FDNIRS-DCS could detect alterations in cerebral hemodynamics beyond cerebral hemoglobin oxygen saturation (SO 2). Eleven SV neonates were recruited and compared to 13 controls. Preoperatively, SV patients showed decreased cerebral blood flow (CBFi ), cerebral oxygen metabolism (CMRO 2i ) and SO 2; and increased oxygen extraction fraction (OEF) compared to controls. Compared to preoperative values, unstable postoperative SV patients had decreased CMRO 2i and CBFi , which returned to baseline when stable. However, SO 2 showed no difference between unstable and stable states. Preoperative SV neonates are flow-limited and show signs of impaired cerebral development compared to controls. FDNIRS-DCS shows potential to improve assessment of cerebral development and postoperative hemodynamics compared to SO 2 alone.
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Affiliation(s)
- Mathieu Dehaes
- Fetal Neonatal Neuroimaging & Developmental Science Center, Division of Newborn Medicine, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
- Mathieu Dehaes is currently at University of Montréal and Centre Hospitalier Universitaire Sainte-Justine, Montréal (QC), H3T 1C5,
Canada
- Mathieu Dehaes and Henry H. Cheng contributed equally to this work
| | - Henry H. Cheng
- Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
- Mathieu Dehaes and Henry H. Cheng contributed equally to this work
| | - Erin M. Buckley
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129,
USA
- Erin M. Buckley is currently at Georgia Institute of Technology, Atlanta, GA 30322,
USA
| | - Pei-Yi Lin
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129,
USA
| | - Silvina Ferradal
- Fetal Neonatal Neuroimaging & Developmental Science Center, Division of Newborn Medicine, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
| | - Kathryn Williams
- Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
| | - Rutvi Vyas
- Fetal Neonatal Neuroimaging & Developmental Science Center, Division of Newborn Medicine, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
| | - Katherine Hagan
- Fetal Neonatal Neuroimaging & Developmental Science Center, Division of Newborn Medicine, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
| | - Daniel Wigmore
- Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
| | - Erica McDavitt
- Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
| | - Janet S. Soul
- Department of Neurology, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
| | - Maria Angela Franceschini
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129,
USA
| | - Jane W. Newburger
- Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
| | - P. Ellen Grant
- Fetal Neonatal Neuroimaging & Developmental Science Center, Division of Newborn Medicine, Boston Children’s Hospital & Harvard Medical School, Boston, MA 02115,
USA
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Liao SMC, Rao R, Mathur AM. Head Position Change Is Not Associated with Acute Changes in Bilateral Cerebral Oxygenation in Stable Preterm Infants during the First 3 Days of Life. Am J Perinatol 2015; 32:645-52. [PMID: 25282608 PMCID: PMC4624398 DOI: 10.1055/s-0034-1390348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Several recent intraventricular hemorrhage prevention bundles include midline head positioning to prevent potential disturbances in cerebral hemodynamics. We aimed to study the impact of head position change on regional cerebral saturations (SctO2) in preterm infants (< 30 weeks gestational age) during the first 3 days of life. STUDY DESIGN Bilateral SctO2 was measured by near-infrared spectroscopy. The infant's head was turned sequentially to each side from midline (baseline) in 30-minute intervals while keeping the body supine. Bilateral SctO2 before and after each position change were compared using paired t-test. RESULTS In relatively stable preterm infants (gestational age 26.5 ± 1.7 weeks, birth weight 930 ± 220 g; n = 20), bilateral SctO2 remained within normal range (71.1-75.3%) when the head was turned from midline position to either side. CONCLUSION Stable preterm infants tolerated brief changes in head position from midline without significant alternation in bilateral SctO2; the impact on critically ill infants needs further evaluation.
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Affiliation(s)
- Steve Ming-Che Liao
- Corresponding author: Steve Ming-Che Liao, MD, MSCI, Division of Newborn Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, Missouri 63130, USA, Tel: 1(314)454-2683 Fax: 1(314)454-4633,
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