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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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Malova M, Parodi A, Severino M, Tortora D, Calevo MG, Traggiai C, Massirio P, Minghetti D, Uccella S, Preiti D, Nobili L, Rossi A, Ramenghi LA. Neurodevelopmental Outcome at 3 Years of Age in Very Low Birth Weight Infants According to Brain Development and Lesions. Curr Pediatr Rev 2024; 20:94-105. [PMID: 36752291 DOI: 10.2174/1573396319666230208092416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND During the last decades, severe brain lesions affecting very low birth weight (<1500 gr, VLBW) infants were gradually substituted by milder lesions with debatable prognoses. OBJECTIVE The objective of this study is to define type, frequency and 3 years of neurodevelopmental outcome of prematurity-related brain lesions in a modern cohort of VLBW infants. METHODS VLBW infants admitted to our NICU in 5 years period with brain MRI at term-equivalent age were included. MRI scans were reviewed to identify and grade white matter lesions (WML), intraventricular hemorrhage (IVH), and cerebellar hemorrhage (CBH). Linear measurements of brain size, biparietal width (BPW) and trans-cerebellar diameter (TCD) were carried out. Total maturation score (TMS) was calculated. Developmental Coefficients (DQ) on Griffiths Scale at 3 years of age were compared between patients with different types and grades of lesions and patients without lesions; possible correlations between linear brain measurements, brain maturation and outcome were explored. RESULTS Study included 407 patients. Of them, 187 (46%) had at least one brain lesion on MRI, while 37 (9%) had severe lesions. The most frequent lesion was IVH (28%), followed by WML (21%) and CBH (17%). Mild and severe IVH, moderate and severe WML and all grades of CBH were related to worst outcome at 3 years. In patients without lesions, small BPW and small TCD were associated with worse outcomes. No correlations were observed between TMS and outcome. CONCLUSION We have observed that even mild brain lesions have a negative influence on neurological outcome at 3 years of age.
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Affiliation(s)
- Mariya Malova
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Domenico Tortora
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Cristina Traggiai
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Paolo Massirio
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sara Uccella
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Deborah Preiti
- Psychology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, 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, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
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Zhang Y, Liu D, Mao Y, Gao Q, Xiong T. Cerebral near-infrared spectroscopy monitoring to predict periventricular-intraventricular haemorrhage and neurodevelopmental outcomes in preterm infants: a protocol for a systematic review and meta-analysis. BMJ Paediatr Open 2023; 7:e001859. [PMID: 37311622 DOI: 10.1136/bmjpo-2023-001859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/01/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Periventricular-intraventricular haemorrhage (PV-IVH) is one of the major cause of mortality and long-term neurodevelopmental sequela in preterm infants born at less than 32 weeks of gestation. Near-infrared spectroscopy (NIRS) monitoring can detect brain tissue oxygen saturation changes before the occurrence of PV-IVH in the early postnatal period. However, the time window for NIRS monitoring, the absolute value or change value of brain tissue oxygen saturation, and the accuracy of NIRS in predicting PV-IVH and its neurodevelopmental outcomes has not been systematically reviewed. In this review, we will investigate the diagnostic accuracy (sensitivity, specificity and accuracy) of NIRS in predicting PV-IVH, its severity and outcomes. METHODS AND ANALYSIS Literature will be searched in the PubMed, EMBASE, Web of Science and Cochrane Library databases without limitation of region or time of publication. All published literature without language restrictions, including randomised/quasicontrolled trials and observational studies, will be considered. Studies providing index test values (the absolute value or change value of oxygen saturation using NIRS) will be included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (DTA) process will be followed for writing. The risk of bias will be assessed according to the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The outcomes will be the diagnostic accuracy (sensitivity, specificity and accuracy) of NIRS in predicting PV-IVH, long-term neurodevelopmental outcomes and infant mortality. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool will be used to evaluate the quality of the evidence. ETHICS AND DISSEMINATION In this systematic review, data will be collected from published articles for collation and analysis, without a separate ethical review. PROSPERO REGISTRATION NUMBER CRD42022316080.
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Affiliation(s)
- Yao Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Dengjun Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Yanxia Mao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Qian Gao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
| | - Tao Xiong
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China
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Périsset A, Natalucci G, Adams M, Karen T, Bassler D, Hagmann C. Impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in very preterm infants at two years of age. Early Hum Dev 2023; 177-178:105721. [PMID: 36841201 DOI: 10.1016/j.earlhumdev.2023.105721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND High-grade intraventricular hemorrhage (IVH) in very preterm infants is a known risk factor for adverse neurodevelopmental outcome. Prognosis is less clear for low-grade (grades I/II) IVH however, with conflicting study results in recent years. OBJECTIVE To evaluate the impact of low-grade IVH on neurodevelopmental outcome at 2 years corrected age in preterm infants born below 32 weeks gestation at the University hospital of Zurich between 2009 and 2014. METHODS Among 843 live-born preterm infants born during the observation period, 509 were included in our study. Exclusion criteria were death, high-grade IVH, cystic periventricular leukomalacia and congenital malformations. Infants were grouped into those with or without low-grade IVH according to cranial ultrasound. Neurodevelopmental impairment (NDI) was defined as cognitive or motor developmental score > 2 standard deviations below the mean and/or CP grades 2-5 and/or moderate/severe vision loss and/or hearing problem corrected with hearing aids. Multivariate linear regression was used to assess effect of low-grade IVH on endpoints while adjusting for other risk factors. RESULTS 87 preterm infants had low-grade IVH (42 grade I, 45 grade II) on cranial ultrasound. These were compared to 422 preterm infants without IVH. Follow-up rate was 82.4 %. Preterm infants with low-grade IVH had higher rates of NDI (21.8 vs 13.3 %, p = 0.047). Infants with IVH grade II had significantly higher rates for CP (8.9 % vs 3.6 %, p = 0.003), visual impairment (20.5 % vs 8.3 %, p = 0.009) and NDI (33.3 % vs 13.3 %, p < 0.001). CONCLUSION In our study, low-grade IVH - and especially IVH grade II - is associated with adverse neurodevelopmental outcome at 2 years of corrected age.
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Affiliation(s)
| | - Giancarlo Natalucci
- Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Switzerland; Family Larsson-Rosenquist Foundation Centre for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University of Zurich and University Hospital Zurich, Switzerland
| | - Mark Adams
- Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Switzerland
| | - Tanja Karen
- Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Switzerland
| | - Dirk Bassler
- Newborn Research, Department of Neonatology, University of Zurich and University Hospital Zurich, Switzerland
| | - Cornelia Hagmann
- Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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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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El-Dib M, Munster C, Sunwoo J, Cherkerzian S, Lee S, Hildrey E, Steele T, Bell K, Franceschini MA, Volpe JJ, Inder T. Association of early cerebral oxygen saturation and brain injury in extremely preterm infants. J Perinatol 2022; 42:1385-1391. [PMID: 35790852 DOI: 10.1038/s41372-022-01447-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the association between cerebral saturation (crSO2) using Near-Infrared Spectroscopy (NIRS) and brain injury in extremely preterm infants. STUDY DESIGN This retrospective study includes 62 infants (<28 weeks gestation) who underwent continuous NIRS monitoring in the first 5 days after birth. Median crSO2 were compared in 12 h increments between infants with and without germinal matrix/intraventricular hemorrhage (GM/IVH). crSO2 was also compared by IVH severity, onset, and by grade of injury on term equivalent MRI. RESULTS After 48 h of life (HOL), infants with GM/IVH had significantly lower crSO2 than those without GM/IVH in analysis adjusted for potential confounding e.g., at 49-60 HOL (69.5 (66.2, 72.8) vs. 74.7 (71.8, 77.6), p = 0.023). There were no significant differences in crSO2 by IVH subcategory or injury severity on MRI. CONCLUSION Clinical use of NIRS has the potential to identify crSO2 patterns associated with development of GM/IVH.
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Affiliation(s)
- Mohamed El-Dib
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Chelsea Munster
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John Sunwoo
- Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Sara Cherkerzian
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sarah Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily Hildrey
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Tina Steele
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine Bell
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maria Angela Franceschini
- Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph J Volpe
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Children's Hospital, Boston, USA
| | - Terrie Inder
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Abstract
While intraventricular hemorrhage (IVH) predominantly damages the periventricular white matter, it induces substantial injury to the cerebral gray matter. IVH destroys the germinal matrix, suppresses neurogenesis, and disrupts corticogenesis, thereby reducing the number of neurons in the upper cortical layer and volume of the cerebral gray matter. The pathogenesis of gray matter injury is attributed to IVH-induced oxidative stress, inflammation, and mass effect damaging the germinal matrix as well as to post-hemorrhagic ventricular dilation (PHVD). The IVH-induced cerebral gray matter injury and PHVD contribute to cognitive deficits and neurobehavioral disorders. Neuroimaging has enhanced our understanding of cerebral gray matter injury and is a valuable predictor of neurodevelopmental outcomes. Evidence from therapies tested in preclinical models and clinical trials suggests that strategies to promote neurogenesis, reduce cerebral inflammation and oxidative stress, and remove blood clots from the ventricles might enhance the outcome of these infants. This review offers an integrated view of new insights into the mechanisms underlying gray matter injury in premature infants with IVH and highlights the imminent therapies to restore neurodevelopmental dysfunction in IVH survivors.
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Affiliation(s)
- Deep Sharma
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Alex Agyemang
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Praveen Ballabh
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA.
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Matyas M, Iancu M, Hasmasanu M, Man A, Zaharie G. Association Analysis of the Cerebral Fractional Tissue Oxygen Extraction (cFTOE) and the Cerebral Oxygen Saturation (crSaO 2) with Perinatal Factors in Preterm Neonates: A Single Centre Study. J Clin Med 2022; 11:jcm11123546. [PMID: 35743612 PMCID: PMC9224851 DOI: 10.3390/jcm11123546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 12/03/2022] Open
Abstract
(1) Background: Near-infrared spectroscopy (NIRS) is a non-invasive, easily performed method of monitoring brain oxygenation. The regional cerebral oxygen saturation (crSaO2) and the cerebral fractional tissue oxygen extraction (cFTOE) evaluated by NIRS provide more accurate information on brain oxygenation than the blood oxygen saturation. We investigated the effect of perinatal factors on cerebral oxygenation of preterm newborns. (2) Methods: We conducted a longitudinal study with 48 preterm newborns <34 weeks of gestation who underwent NIRS registration during the first 72 h of life. crSaO2 was measured and cFTOE was calculated foreach patient. (3) Results: One-way ANOVA showed no significant main effect of IVH severity on crSaO2 and cFTOE (p > 0.05); there was a tendency toward statistical significance concerning the difference between the means of crSaO2 (p = 0.083) and cFTOE (p = 0.098). Patients with intraventricular haemorrhage (IVH) had a lower mean of crSaO2 and a higher mean of cFTOE (59.67 ± 10.37% vs. 64.92 ± 10.16% for crSaO2; 0.37 ± 0.11 vs. 0.32 ± 0.11 for cFTOE) compared to those with no IVH. Significantly lower values of crSaO2 and higher values of cFTOE were found in neonates receiving inotropic treatment (p < 0.0001). Episodes of apnoea also proved to influence the cerebral oxygen saturation of the study group (p = 0.0026). No significant association between the maternal hypertension treatment and the cerebral oxygenation of preterms was found. (4) Conclusions: This study showed a decreased cerebral oxygen saturation of preterms with IVH, inotrope support and apnoea episodes.
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Affiliation(s)
- Melinda Matyas
- Neonatology Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 3, Clinicilor Street, 400012 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
| | - Mihaela Iancu
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 8, Victor Babes Street, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-0740-130-888
| | - Monica Hasmasanu
- Neonatology Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 3, Clinicilor Street, 400012 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
| | - Anca Man
- Neonatology Department, County Emergency Hospital, 3, Clinicilor Street, 400347 Cluj-Napoca, Romania;
| | - Gabriela Zaharie
- Neonatology Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, 3, Clinicilor Street, 400012 Cluj-Napoca, Romania; (M.M.); (M.H.); (G.Z.)
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Stout JN, Lin PY, Sutin J, Higgins J, Ellen Grant P. Magnetic resonance imaging metrics of oxygen extraction fraction: Contradictions or insight into pathophysiological mechanisms? Am J Hematol 2022; 97:679-681. [PMID: 35405034 PMCID: PMC10353571 DOI: 10.1002/ajh.26567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Jeffrey N. Stout
- Fetal Neonatal Neuroimaging and Developmental Science
Center, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Pei-Yi Lin
- Fetal Neonatal Neuroimaging and Developmental Science
Center, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Jason Sutin
- Fetal Neonatal Neuroimaging and Developmental Science
Center, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - John Higgins
- Center for Systems Biology and Department of Pathology,
Massachusetts General Hospital Boston, Department of Systems Biology, Harvard
Medical School, Boston, Massachusetts, USA
| | - P. Ellen Grant
- Fetal Neonatal Neuroimaging and Developmental Science
Center, Boston Children’s Hospital, Harvard Medical School, Boston,
Massachusetts, USA
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10
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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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11
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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] [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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12
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Levy PT, Pellicer A, Schwarz CE, Neunhoeffer F, Schuhmann MU, Breindahl M, Fumagelli M, Mintzer J, de Boode W. Near-infrared spectroscopy for perioperative assessment and neonatal interventions. Pediatr Res 2021:10.1038/s41390-021-01791-1. [PMID: 34716423 DOI: 10.1038/s41390-021-01791-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022]
Abstract
Perioperative applications of near-infrared spectroscopy (NIRS) to monitor regional tissue oxygenation and perfusion in cardiac and noncardiac surgery are of increasing interest in neonatal care. Complex neonatal surgery can impair adequate oxygen delivery and tissue oxygen consumption and increase the risk of neurodevelopmental delay. Coupled with conventional techniques, NIRS monitoring may enable targeted hemodynamic management of the circulation in both cardiac and noncardiac surgical procedures. In this narrative review, we discuss the application of perioperative NIRS in specific neonatal interventions, including surgical intervention for congenital heart defects, definitive closure of the patent ductus arteriosus, neurological and gastrointestinal disorders, and use of extracorporeal membrane oxygenation. We identified areas for future research within disease-specific indications and offer a roadmap to aid in developing evidence-based targeted diagnostic and management strategies in neonates. IMPACT: There is growing recognition that perioperative NIRS monitoring, used in conjunction with conventional monitoring, may provide critical hemodynamic information that either complements clinical impressions or delivers novel physiologic insight into the neonatal circulatory and perfusion pathways.
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Affiliation(s)
- Philip T Levy
- Department of Pediatrics, Harvard Medical School and Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Adelina Pellicer
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Christoph E Schwarz
- Department of Neonatology, University Children's Hospital, Tübingen, Germany
- Infant Research centre, University College Cork Ireland, Cork, Ireland
| | - Felix Neunhoeffer
- Department of Pediatric Cardiology, Pulmonology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - Martin U Schuhmann
- Department of Neurosurgery, University Hospital Tübingen, 72076, Tübingen, Germany
| | - Morten Breindahl
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Monica Fumagelli
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Jonathan Mintzer
- Division of Newborn Medicine, Department of Pediatrics, Mountainside Medical Center, Montclair, NJ, USA
| | - Willem de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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13
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Huang C, Mazdeyasna S, Mohtasebi M, Saatman KE, Cheng Q, Yu G, Chen L. Speckle contrast diffuse correlation tomography of cerebral blood flow in perinatal disease model of neonatal piglets. JOURNAL OF BIOPHOTONICS 2021; 14:e202000366. [PMID: 33295142 PMCID: PMC8833087 DOI: 10.1002/jbio.202000366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 05/11/2023]
Abstract
We adapted and tested an innovative noncontact speckle contrast diffuse correlation tomography (scDCT) system for 3D imaging of cerebral blood flow (CBF) variations in perinatal disease models utilizing neonatal piglets, which closely resemble human neonates. CBF variations were concurrently measured by the scDCT and an established diffuse correlation spectroscopy (DCS) during global ischemia, intraventricular hemorrhage, and asphyxia; significant correlations were observed. Moreover, CBF variations associated reasonably with vital pathophysiological changes. In contrast to DCS measurements of mixed signals from local scalp, skull and brain, scDCT generates 3D images of CBF distributions at prescribed depths within the head, thus enabling specific determination of regional cerebral ischemia. With further optimization and validation in animals and human neonates, scDCT has the potential to be a noninvasive imaging tool for both basic neuroscience research in laboratories and clinical applications in neonatal intensive care units.
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Affiliation(s)
- Chong Huang
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
| | - Siavash Mazdeyasna
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
| | - Mehrana Mohtasebi
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
| | - Kathryn E. Saatman
- Department of Physiology, Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky
| | - Qiang Cheng
- Division of Biomedical Informatics, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
| | - Guoqiang Yu
- Department of Biomedical Engineering, University of Kentucky, Lexington, Kentucky
| | - Lei Chen
- Department of Physiology, Spinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, Kentucky
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14
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Egesa WI, Odoch S, Odong RJ, Nakalema G, Asiimwe D, Ekuk E, Twesigemukama S, Turyasiima M, Lokengama RK, Waibi WM, Abdirashid S, Kajoba D, Kumbakulu PK. Germinal Matrix-Intraventricular Hemorrhage: A Tale of Preterm Infants. Int J Pediatr 2021; 2021:6622598. [PMID: 33815512 PMCID: PMC7987455 DOI: 10.1155/2021/6622598] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/26/2021] [Indexed: 12/15/2022] Open
Abstract
Germinal matrix-intraventricular hemorrhage (GM-IVH) is a common intracranial complication in preterm infants, especially those born before 32 weeks of gestation and very-low-birth-weight infants. Hemorrhage originates in the fragile capillary network of the subependymal germinal matrix of the developing brain and may disrupt the ependymal lining and progress into the lateral cerebral ventricle. GM-IVH is associated with increased mortality and abnormal neurodevelopmental outcomes such as posthemorrhagic hydrocephalus, cerebral palsy, epilepsy, severe cognitive impairment, and visual and hearing impairment. Most affected neonates are asymptomatic, and thus, diagnosis is usually made using real-time transfontanellar ultrasound. The present review provides a synopsis of the pathogenesis, grading, incidence, risk factors, and diagnosis of GM-IVH in preterm neonates. We explore brief literature related to outcomes, management interventions, and pharmacological and nonpharmacological prevention strategies for GM-IVH and posthemorrhagic hydrocephalus.
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Affiliation(s)
- Walufu Ivan Egesa
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Simon Odoch
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Richard Justin Odong
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Gloria Nakalema
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Daniel Asiimwe
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Eddymond Ekuk
- Department of Surgery, Faculty of Medicine, Mbarara University of Science and Technology, Uganda
| | - Sabinah Twesigemukama
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Munanura Turyasiima
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Rachel Kwambele Lokengama
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - William Mugowa Waibi
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Said Abdirashid
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Dickson Kajoba
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
| | - Patrick Kumbowi Kumbakulu
- Department of Paediatrics and Child Health, Faculty of Clinical Medicine and Dentistry, Kampala International University, Uganda
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15
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Peng C, Hou X. Applications of functional near-infrared spectroscopy (fNIRS) in neonates. Neurosci Res 2020; 170:18-23. [PMID: 33347910 DOI: 10.1016/j.neures.2020.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
Functional near-infrared spectroscopy (fNIRS) is a method of monitoring brain oxygenation. This technique investigates hemodynamic changes in the cerebral cortex. fNIRS is widely used in clinical and scientific research. In this review, we focus on the applications of fNIRS on neonates. Here, applications form two distinct categories: task associated studies, and hemoglobin phase change studies. fNIRS is non-invasive, easily performed, and repeatable. However, it has limited monitoring depth and spatial resolution when used in newborns. Moreover, with recent technological advances, it is now possible to explore neuronal activity patterns using fNIRS in both healthy and pathological conditions. For more than 20 years, fNIRS has enabled clinicians to gain insight into cerebral development and mechanisms of injury in neonates. fNIRS is a useful supplement to existing technologies due to its ability to interrogate the neonatal brain function.
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Affiliation(s)
- Cheng Peng
- Department of Neonatal Ward, Peking University First Hospital, Beijing, 100034, China
| | - Xinlin Hou
- Department of Neonatal Ward, Peking University First Hospital, Beijing, 100034, China.
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16
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Milej D, Abdalmalak A, Rajaram A, St. Lawrence K. Direct assessment of extracerebral signal contamination on optical measurements of cerebral blood flow, oxygenation, and metabolism. NEUROPHOTONICS 2020; 7:045002. [PMID: 33062801 PMCID: PMC7540337 DOI: 10.1117/1.nph.7.4.045002] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/04/2020] [Indexed: 05/08/2023]
Abstract
Significance: Near-infrared spectroscopy (NIRS) combined with diffuse correlation spectroscopy (DCS) provides a noninvasive approach for monitoring cerebral blood flow (CBF), oxygenation, and oxygen metabolism. However, these methods are vulnerable to signal contamination from the scalp. Our work evaluated methods of reducing the impact of this contamination using time-resolved (TR) NIRS and multidistance (MD) DCS. Aim: The magnitude of scalp contamination was evaluated by measuring the flow, oxygenation, and metabolic responses to a global hemodynamic challenge. Contamination was assessed by collecting data with and without impeding scalp blood flow. Approach: Experiments involved healthy participants. A pneumatic tourniquet was used to cause scalp ischemia, as confirmed by contrast-enhanced NIRS, and a computerized gas system to generate a hypercapnic challenge. Results: Comparing responses acquired with and without the tourniquet demonstrated that the TR-NIRS technique could reduce scalp contributions in hemodynamic signals up to 4 times (r SD = 3 cm ) and 6 times (r SD = 4 cm ). Similarly, blood flow responses from the scalp and brain could be separated by analyzing MD DCS data with a multilayer model. Using these techniques, there was no change in metabolism during hypercapnia, as expected, despite large increases in CBF and oxygenation. Conclusion: NIRS/DCS can accurately monitor CBF and metabolism with the appropriate enhancement to depth sensitivity, highlighting the potential of these techniques for neuromonitoring.
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Affiliation(s)
- Daniel Milej
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Department of Medical Biophysics, London, Ontario, Canada
| | - Androu Abdalmalak
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Department of Medical Biophysics, London, Ontario, Canada
| | - Ajay Rajaram
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Department of Medical Biophysics, London, Ontario, Canada
| | - Keith St. Lawrence
- Lawson Health Research Institute, Imaging Program, London, Ontario, Canada
- Western University, Department of Medical Biophysics, London, Ontario, Canada
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17
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Giovannella M, Andresen B, Andersen JB, El-Mahdaoui S, Contini D, Spinelli L, Torricelli A, Greisen G, Durduran T, Weigel UM, Law I. Validation of diffuse correlation spectroscopy against 15O-water PET for regional cerebral blood flow measurement in neonatal piglets. J Cereb Blood Flow Metab 2020; 40:2055-2065. [PMID: 31665953 PMCID: PMC7786848 DOI: 10.1177/0271678x19883751] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/06/2019] [Accepted: 09/19/2019] [Indexed: 11/15/2022]
Abstract
Diffuse correlation spectroscopy (DCS) can non-invasively and continuously asses regional cerebral blood flow (rCBF) at the cot-side by measuring a blood flow index (BFI) in non-traditional units of cm2/s. We have validated DCS against positron emission tomography using 15O-labeled water (15O-water PET) in a piglet model allowing us to derive a conversion formula for BFI to rCBF in conventional units (ml/100g/min). Neonatal piglets were continuously monitored by the BabyLux device integrating DCS and time resolved near infrared spectroscopy (TRS) while acquiring 15O-water PET scans at baseline, after injection of acetazolamide and during induced hypoxic episodes. BFI by DCS was highly correlated with rCBF (R = 0.94, p < 0.001) by PET. A scaling factor of 0.89 (limits of agreement for individual measurement: 0.56, 1.39)×109× (ml/100g/min)/(cm2/s) was used to derive baseline rCBF from baseline BFI measurements of another group of piglets and of healthy newborn infants showing an agreement with expected values. These results pave the way towards non-invasive, cot-side absolute CBF measurements by DCS on neonates.
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Affiliation(s)
- Martina Giovannella
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
| | - Bjørn Andresen
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Julie B Andersen
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
| | - Sahla El-Mahdaoui
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Davide Contini
- Politecnico di Milano-Dipartimento di Fisica, Milan, Italy
| | - Lorenzo Spinelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Alessandro Torricelli
- Politecnico di Milano-Dipartimento di Fisica, Milan, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Udo M Weigel
- HemoPhotonics S.L., Castelldefels (Barcelona), Spain
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark
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18
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Tortora D, Lo Russo FM, Severino M, Parodi A, Massirio P, Ramenghi LA, Rossi A. Regional impairment of cortical and deep gray matter perfusion in preterm neonates with low-grade germinal matrix-intraventricular hemorrhage: an ASL study. Neuroradiology 2020; 62:1689-1699. [DOI: 10.1007/s00234-020-02514-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022]
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19
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Rajaram A, Yip LCM, Milej D, Suwalski M, Kewin M, Lo M, Carson JJL, Han V, Bhattacharya S, Diop M, de Ribaupierre S, St. Lawrence K. Perfusion and Metabolic Neuromonitoring during Ventricular Taps in Infants with Post-Hemorrhagic Ventricular Dilatation. Brain Sci 2020; 10:E452. [PMID: 32679665 PMCID: PMC7407524 DOI: 10.3390/brainsci10070452] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/03/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023] Open
Abstract
Post-hemorrhagic ventricular dilatation (PHVD) is characterized by a build-up of cerebral spinal fluid (CSF) in the ventricles, which increases intracranial pressure and compresses brain tissue. Clinical interventions (i.e., ventricular taps, VT) work to mitigate these complications through CSF drainage; however, the timing of these procedures remains imprecise. This study presents Neonatal NeuroMonitor (NNeMo), a portable optical device that combines broadband near-infrared spectroscopy (B-NIRS) and diffuse correlation spectroscopy (DCS) to provide simultaneous assessments of cerebral blood flow (CBF), tissue saturation (StO2), and the oxidation state of cytochrome c oxidase (oxCCO). In this study, NNeMo was used to monitor cerebral hemodynamics and metabolism in PHVD patients selected for a VT. Across multiple VTs in four patients, no significant changes were found in any of the three parameters: CBF increased by 14.6 ± 37.6% (p = 0.09), StO2 by 1.9 ± 4.9% (p = 0.2), and oxCCO by 0.4 ± 0.6 µM (p = 0.09). However, removing outliers resulted in significant, but small, increases in CBF (6.0 ± 7.7%) and oxCCO (0.1 ± 0.1 µM). The results of this study demonstrate NNeMo's ability to provide safe, non-invasive measurements of cerebral perfusion and metabolism for neuromonitoring applications in the neonatal intensive care unit.
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Affiliation(s)
- Ajay Rajaram
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Lawrence C. M. Yip
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Daniel Milej
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Marianne Suwalski
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Matthew Kewin
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
| | - Marcus Lo
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
| | - Jeffrey J. L. Carson
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Victor Han
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON N6A 3K7, Canada; (V.H.); (S.B.)
| | - Soume Bhattacharya
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, London Health Sciences Centre, London, ON N6A 3K7, Canada; (V.H.); (S.B.)
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
| | - Sandrine de Ribaupierre
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
- Department of Clinical Neurological Sciences, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Keith St. Lawrence
- Imaging Program, Lawson Health Research Institute, London, ON N6A 4V2, Canada; (L.C.M.Y.); (D.M.); (M.S.); (M.K.); (M.L.); (J.J.L.C.); (M.D.); (K.S.L.)
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 3K7, Canada;
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20
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Serelaxin activates eNOS, suppresses inflammation, attenuates developmental delay and improves cognitive functions of neonatal rats after germinal matrix hemorrhage. Sci Rep 2020; 10:8115. [PMID: 32415164 PMCID: PMC7229117 DOI: 10.1038/s41598-020-65144-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/27/2020] [Indexed: 12/14/2022] Open
Abstract
Germinal matrix hemorrhage (GMH) is a detrimental form of neonatal CNS injury. Following GMH-mediated eNOS inhibition, inflammation arises, contributing to GMH-induced brain injury. We investigated the beneficial effects of Serelaxin, a clinical tested recombinant Relaxin-2 protein, on brain injury after GMH in rats. We investigated whether effects of Serelaxin are mediated by its ability to activate the GMH-suppressed eNOS pathway resulting in attenuation of inflammatory marker overproduction. GMH was induced by intraparenchymal injection of bacterial collagenase (0.3U). Seven day old Sprague–Dawley rat pups (P7) were used (n = 63). GMH animals were divided in vehicle or serelaxin treated (3 µg once, 30 µg once, 30 µg multiple, i.p., starting 30 after GMH and then daily). Sham operated animals were used. We monitored the developmental profile working memory and spatial function (T-maze and open field test respectively). At day 28, all rats underwent MRI-scans for assessment of changes in cortical thickness and white matter loss. Effects of Serelaxin on eNOS pathway activation and post-GMH inflammation were evaluated. We demonstrated that Serelaxin dose-dependently attenuated GMH-induced developmental delay, protected brain and improved cognitive functions of rats after GMH. That was associated with the decreased post-GMH inflammation, mediated at least partly by amelioration of GMH-induced eNOS inhibition.
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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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22
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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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Al-Mouqdad MM, Abdelrahim A, Abdalgader AT, Alyaseen N, Khalil TM, Taha MY, Asfour SS. Risk factors for intraventricular hemorrhage in premature infants in the central region of Saudi Arabia. Int J Pediatr Adolesc Med 2019; 8:76-81. [PMID: 34084876 PMCID: PMC8144857 DOI: 10.1016/j.ijpam.2019.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/09/2019] [Accepted: 11/21/2019] [Indexed: 01/21/2023]
Abstract
Background Intraventricular hemorrhage (IVH) is a serious complication of premature (<32 weeks) deliveries, especially in very-low-birth-weight (VLBW; <1500 g) neonates. Infants developing severe IVH are more prone to long-term developmental disabilities. Although 62%–79% of women in Saudi Arabia receive antenatal steroids, IVH incidence remains high. We analyzed the risk factors for IVH in preterm VLBW neonates in the central region of Saudi Arabia. Methods We included premature infants with IVH (n = 108) and gestational age- and birth weight-matched control group infants (n = 108) admitted to our neonatal intensive care unit. Cases were divided into mild (grades I and II; n = 56) and severe (grades III and IV; n = 52) IVH groups. Association of IVH with risk factors in the first week of life was investigated. Results The following risk factors were associated with severe IVH: lack of antenatal steroid administration (P < .001), pulmonary hemorrhage (P = .023), inotrope use (P = .032), neonatal hydrocortisone administration (P = .001), and patent ductus arteriosus (PDA) (P = .005). Multivariable logistic regression analysis revealed the following to be significant: lack of antenatal dexamethasone (adjusted odds ratio [aOR]: 0.219, 95% confidence interval [95% CI] 0.087–0.546), neonatal hydrocortisone administration (aOR: 3.519, 95% CI 1.204–10.281), and PDA (aOR: 2.718, 95% CI 1.024–7.210). Low hematocrit in the first 3 days of life was significantly associated with severe IVH (all P < .01). Conclusions Failure to receive antenatal dexamethasone, PDA, hydrocortisone administration for neonatal hypotension, and low hematocrit in the first 3 days of life was associated with severe IVH in VLBW neonates. Clinicians and healthcare policy makers should consider these factors during decision-making.
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Affiliation(s)
| | - Adli Abdelrahim
- Neonatal Intensive Care Unit, Hospital of Paediatrics, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Nowf Alyaseen
- General Paediatrics Department, Hospital of Paediatrics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Thanaa Mustafa Khalil
- Obstetric and Gynecology Department, Maternity Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Muhammed Yassen Taha
- Pharmacy Department, Pharmaceutical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Suzan Suhail Asfour
- Clinical Pharmacy Department, Pharmaceutical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
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Santhosh D, Sherman J, Chowdhury S, Huang Z. Harnessing region-specific neurovascular signaling to promote germinal matrix vessel maturation and hemorrhage prevention. Dis Model Mech 2019; 12:dmm.041228. [PMID: 31601549 PMCID: PMC6899033 DOI: 10.1242/dmm.041228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 10/06/2019] [Indexed: 12/13/2022] Open
Abstract
Germinal matrix hemorrhage (GMH), affecting about 1 in 300 births, is a major perinatal disease with lifelong neurological consequences. Yet despite advances in neonatal medicine, there is no effective intervention. GMH is characterized by localized bleeding in the germinal matrix (GM), due to inherent vessel fragility unique to this developing brain region. Studies have shown that reduced TGFβ signaling contributes to this vascular immaturity. We have previously shown that a region-specific G-protein-coupled receptor pathway in GM neural progenitor cells regulates integrin β8, a limiting activator of pro-TGFβ. In this study, we use mice to test whether this regional pathway can be harnessed for GMH intervention. We first examined the endogenous dynamics of this pathway and found that it displays specific patterns of activation. We then investigated the functional effects of altering these dynamics by chemogenetics and found that there is a narrow developmental window during which this pathway is amenable to manipulation. Although high-level activity in this time window interferes with vessel growth, moderate enhancement promotes vessel maturation without compromising growth. Furthermore, we found that enhancing the activity of this pathway in a mouse model rescues all GMH phenotypes. Altogether, these results demonstrate that enhancing neurovascular signaling through pharmacological targeting of this pathway may be a viable approach for tissue-specific GMH intervention. They also demonstrate that timing and level are likely two major factors crucial for success. These findings thus provide critical new insights into both brain neurovascular biology and the intervention of GMH.
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Affiliation(s)
- Devi Santhosh
- Departments of Neuroscience and Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA.,Program in Genetics and Medical Genetics, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Joe Sherman
- Departments of Neuroscience and Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Shafi Chowdhury
- Departments of Neuroscience and Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Zhen Huang
- Departments of Neuroscience and Neurology, University of Wisconsin-Madison, Madison, WI 53705, USA .,Program in Genetics and Medical Genetics, University of Wisconsin-Madison, Madison, WI 53705, USA
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25
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Nourhashemi M, Mahmoudzadeh M, Goudjil S, Kongolo G, Wallois F. Neurovascular coupling in the developing neonatal brain at rest. Hum Brain Mapp 2019; 41:503-519. [PMID: 31600024 PMCID: PMC7268021 DOI: 10.1002/hbm.24818] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 07/21/2019] [Accepted: 09/26/2019] [Indexed: 12/19/2022] Open
Abstract
The neonatal brain is an extremely dynamic organization undergoing essential development in terms of connectivity and function. Several functional imaging investigations of the developing brain have found neurovascular coupling (NVC) patterns that contrast with those observed in adults. These discrepancies are partly due to that NVC is still developing in the neonatal brain. To characterize the vascular response to spontaneous neuronal activations, a multiscale multimodal noninvasive approach combining simultaneous electrical, hemodynamic, and metabolic recordings has been developed for preterm infants. Our results demonstrate that the immature vascular network does not adopt a unique strategy to respond to spontaneous cortical activations. NVC takes on different forms in the same preterm infant during the same recording session in response to very similar types of neural activation. This includes (a) positive stereotyped hemodynamic responses (increases in HbO, decreases in HbR together with increases in rCBF and rCMRO2), (b) negative hemodynamic responses (increases in HbR, decreases in HbO together with decreases in rCBF and rCMRO2), and (c) Increases and decreases in both HbO‐HbR and rCMRO2 together with no changes in rCBF. Age‐related NVC maturation is demonstrated in preterm infants, which can contribute to a better understanding/prevention of cerebral hemodynamic risks in these infants.
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Affiliation(s)
- Mina Nourhashemi
- INSERM U 1105, GRAMFC, Université de Picardie, CHU Sud, rue René Laennec, Amiens Cedex 1, France
| | - Mahdi Mahmoudzadeh
- INSERM U 1105, GRAMFC, Université de Picardie, CHU Sud, rue René Laennec, Amiens Cedex 1, France
| | - Sabrina Goudjil
- INSERM U 1105, GRAMFC, Université de Picardie, CHU Sud, rue René Laennec, Amiens Cedex 1, France
| | - Guy Kongolo
- INSERM U 1105, GRAMFC, Université de Picardie, CHU Sud, rue René Laennec, Amiens Cedex 1, France
| | - Fabrice Wallois
- INSERM U 1105, GRAMFC, Université de Picardie, CHU Sud, rue René Laennec, Amiens Cedex 1, France
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26
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Khalid M, Milej D, Rajaram A, Abdalmalak A, Morrison L, Diop M, St. Lawrence K. Development of a stand-alone DCS system for monitoring absolute cerebral blood flow. BIOMEDICAL OPTICS EXPRESS 2019; 10:4607-4620. [PMID: 31565512 PMCID: PMC6757462 DOI: 10.1364/boe.10.004607] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 05/23/2023]
Abstract
Diffuse correlation spectroscopy (DCS) is a noninvasive optical technique for monitoring cerebral blood flow (CBF). This work presents a stand-alone DCS system capable of monitoring absolute CBF by incorporating a quantitative dynamic contrast-enhanced (DCE) technique. Multi-distance data were acquired to measure the tissue optical properties and to perform DCE experiments. Feasibility of the technique was assessed in piglets in which the optical properties were measured independently by time-resolved near-infrared spectroscopy. A strong linear correlation was observed between CBF values derived using the two sets of optical properties, demonstrating that this hybrid DCS approach can provide real-time monitoring of absolute CBF.
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Affiliation(s)
- Mahro Khalid
- Imaging Program, Lawson Health Research Institute, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Daniel Milej
- Imaging Program, Lawson Health Research Institute, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Ajay Rajaram
- Imaging Program, Lawson Health Research Institute, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Androu Abdalmalak
- Imaging Program, Lawson Health Research Institute, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Laura Morrison
- Imaging Program, Lawson Health Research Institute, London, Ontario, N6A 4V2, Canada
| | - Mamadou Diop
- Imaging Program, Lawson Health Research Institute, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
| | - Keith St. Lawrence
- Imaging Program, Lawson Health Research Institute, London, Ontario, N6A 4V2, Canada
- Department of Medical Biophysics, Western University, London, Ontario, N6A 5C1, Canada
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27
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Giovannella M, Spinelli L, Pagliazzi M, Contini D, Greisen G, Weigel UM, Torricelli A, Durduran T. Accuracy and precision of tissue optical properties and hemodynamic parameters estimated by the BabyLux device: a hybrid time-resolved near-infrared and diffuse correlation spectroscopy neuro-monitor. BIOMEDICAL OPTICS EXPRESS 2019; 10:2556-2579. [PMID: 31149383 PMCID: PMC6524603 DOI: 10.1364/boe.10.002556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 03/29/2019] [Accepted: 04/17/2019] [Indexed: 05/20/2023]
Abstract
We have investigated the accuracy and precision of "the BabyLux device", a hybrid time-resolved near-infrared (TRS) and diffuse correlation spectroscopy (DCS) neuro-monitor for the pre-term infant. Numerical data with realistic noise were simulated and analyzed using the BabyLux device as a reference system and different experimental and analysis parameters. The results describe the limits for the precision and the accuracy to be expected. The dependence of these limits on different experimental conditions and choices of the analysis method is also described. Experiments demonstrate comparable values for precision with respect to the simulation results.
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Affiliation(s)
- Martina Giovannella
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona),
Spain
| | - Lorenzo Spinelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan,
Italy
| | - Marco Pagliazzi
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona),
Spain
| | - Davide Contini
- Politecnico di Milano-Dipartimento di Fisica, Milan,
Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshopitalet, Copenhagen,
Denmark
| | - Udo M. Weigel
- HemoPhotonics S.L., Castelldefels (Barcelona),
Spain
| | - Alessandro Torricelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan,
Italy
- Politecnico di Milano-Dipartimento di Fisica, Milan,
Italy
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona),
Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona,
Spain
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28
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Giovannella M, Contini D, Pagliazzi M, Pifferi A, Spinelli L, Erdmann R, Donat R, Rocchetti I, Rehberger M, König N, Schmitt R, Torricelli A, Durduran T, Weigel UM. BabyLux device: a diffuse optical system integrating diffuse correlation spectroscopy and time-resolved near-infrared spectroscopy for the neuromonitoring of the premature newborn brain. NEUROPHOTONICS 2019; 6:025007. [PMID: 31093515 PMCID: PMC6509945 DOI: 10.1117/1.nph.6.2.025007] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 04/12/2019] [Indexed: 05/06/2023]
Abstract
The BabyLux device is a hybrid diffuse optical neuromonitor that has been developed and built to be employed in neonatal intensive care unit for the noninvasive, cot-side monitoring of microvascular cerebral blood flow and blood oxygenation. It integrates time-resolved near-infrared and diffuse correlation spectroscopies in a user-friendly device as a prototype for a future medical grade device. We present a thorough characterization of the device performance using test measurements in laboratory settings. Tests on solid phantoms report an accuracy of optical property estimation of about 10%, which is expected when using the photon diffusion equation as the model. The measurement of the optical and dynamic properties is stable during several hours of measurements within 3% of the average value. In addition, these measurements are repeatable between different days of measurement, showing a maximal variation of 5% in the optical properties and 8% for the particle diffusion coefficient on a liquid phantom. The variability over test/retest evaluation is < 3 % . The integration of the two modalities is robust and without any cross talk between the two. We also perform in vivo measurements on the adult forearm during arterial cuff occlusion to show that the device can measure a wide range of tissue hemodynamic parameters. We suggest that this platform can form the basis of the next-generation neonatal neuromonitors to be developed for extensive, multicenter clinical testing.
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Affiliation(s)
- Martina Giovannella
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Barcelona, Spain
| | - Davide Contini
- Politecnio di Milano-Dipartimento di Fisica, Milan, Italy
| | - Marco Pagliazzi
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Barcelona, Spain
| | - Antonio Pifferi
- Politecnio di Milano-Dipartimento di Fisica, Milan, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Lorenzo Spinelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | | | - Roger Donat
- Loop-Competitive Design Network, Sant Cugat del Vallès (Barcelona), Barcelona, Spain
| | - Ignacio Rocchetti
- Loop-Competitive Design Network, Sant Cugat del Vallès (Barcelona), Barcelona, Spain
| | | | - Niels König
- Fraunhofer Institute for Production Technology IPT, Aachen, Germany
| | - Robert Schmitt
- Fraunhofer Institute for Production Technology IPT, Aachen, Germany
- RWTH Aachen University, Laboratory for Machine Tools and Production Engineering (WZL), Aachen, Germany
| | - Alessandro Torricelli
- Politecnio di Milano-Dipartimento di Fisica, Milan, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milan, Italy
| | - Turgut Durduran
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Castelldefels (Barcelona), Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Address all correspondence to Turgut Durduran, E-mail:
| | - Udo M. Weigel
- HemoPhotonics S.L., Castelldefels (Barcelona), Barcelona, Spain
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Hendrikx D, Smits A, Lavanga M, De Wel O, Thewissen L, Jansen K, Caicedo A, Van Huffel S, Naulaers G. Measurement of Neurovascular Coupling in Neonates. Front Physiol 2019; 10:65. [PMID: 30833901 PMCID: PMC6387909 DOI: 10.3389/fphys.2019.00065] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/21/2019] [Indexed: 01/01/2023] Open
Abstract
Neurovascular coupling refers to the mechanism that links the transient neural activity to the subsequent change in cerebral blood flow, which is regulated by both chemical signals and mechanical effects. Recent studies suggest that neurovascular coupling in neonates and preterm born infants is different compared to adults. The hemodynamic response after a stimulus is later and less pronounced and the stimulus might even result in a negative (hypoxic) signal. In addition, studies both in animals and neonates confirm the presence of a short hypoxic period after a stimulus in preterm infants. In clinical practice, different methodologies exist to study neurovascular coupling. The combination of functional magnetic resonance imaging or functional near-infrared spectroscopy (brain hemodynamics) with EEG (brain function) is most commonly used in neonates. Especially near-infrared spectroscopy is of interest, since it is a non-invasive method that can be integrated easily in clinical care and is able to provide results concerning longer periods of time. Therefore, near-infrared spectroscopy can be used to develop a continuous non-invasive measurement system, that could be used to study neonates in different clinical settings, or neonates with different pathologies. The main challenge for the development of a continuous marker for neurovascular coupling is how the coupling between the signals can be described. In practice, a wide range of signal interaction measures exist. Moreover, biomedical signals often operate on different time scales. In a more general setting, other variables also have to be taken into account, such as oxygen saturation, carbon dioxide and blood pressure in order to describe neurovascular coupling in a concise manner. Recently, new mathematical techniques were developed to give an answer to these questions. This review discusses these recent developments.
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Affiliation(s)
- Dries Hendrikx
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Mario Lavanga
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Ofelie De Wel
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Liesbeth Thewissen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- Child Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Alexander Caicedo
- Facultad de Ciencias Naturales y Matemáticas, Universidad del Rosario, Bogotá, Colombia
| | - Sabine Van Huffel
- Department of Electrical Engineering, KU Leuven, Leuven, Belgium
- imec, Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
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30
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Leijser LM, de Vries LS. Preterm brain injury: Germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:173-199. [PMID: 31324310 DOI: 10.1016/b978-0-444-64029-1.00008-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Germinal matrix hemorrhage and intraventricular hemorrhages (GMH-IVH) remain a common and clinically significant problem in preterm infants, particularly extremely preterm infants. A large GMH-IVH is often complicated by posthemorrhagic ventricular dilation (PHVD) or parenchymal hemorrhagic infarction and is associated with an increased risk of adverse neurologic sequelae. The widespread use of cranial ultrasonography since the early 1980s has shown a gradual decrease in the incidence of GMH-IVH and has helped with the identification of antenatal and perinatal risk factors and timing of the lesion. The increased use of magnetic resonance imaging (MRI) has contributed to more detailed visualization of the site and extent of the GMH-IVH. In addition, MRI has contributed to the awareness of associated white matter changes as well as associated cerebellar hemorrhages. Although GMH-IVH and PHVD still cannot be prevented, cerebrospinal fluid drainage initiated in the early stage of PHVD development seems to be associated with a better neurodevelopmental outcome. Further studies are underway to improve treatment strategies for PHVD and to potentially prevent and repair GMH-IVH and PHVD and associated brain injury. This chapter discusses the pathogenesis, incidence, risk factors, and management, including preventive measures, of GHM-IVH and PHVD.
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Affiliation(s)
- Lara M Leijser
- Department of Pediatrics, Section of Neonatology, University of Calgary, Cumming School of Medicine, Calgary, Canada
| | - Linda S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Mahdi ES, Bouyssi-Kobar M, Jacobs MB, Murnick J, Chang T, Limperopoulos C. Cerebral Perfusion Is Perturbed by Preterm Birth and Brain Injury. AJNR Am J Neuroradiol 2018; 39:1330-1335. [PMID: 29748205 DOI: 10.3174/ajnr.a5669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/23/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early disturbances in systemic and cerebral hemodynamics are thought to mediate prematurity-related brain injury. However, the extent to which CBF is perturbed by preterm birth is unknown. Our aim was to compare global and regional CBF in preterm infants with and without brain injury on conventional MR imaging using arterial spin-labeling during the third trimester of ex utero life and to examine the relationship between clinical risk factors and CBF. MATERIALS AND METHODS We prospectively enrolled preterm infants younger than 32 weeks' gestational age and <1500 g and performed arterial spin-labeling MR imaging studies. Global and regional CBF in the cerebral cortex, thalami, pons, and cerebellum was quantified. Preterm infants were stratified into those with and without structural brain injury. We further categorized preterm infants by brain injury severity: moderate-severe and mild. RESULTS We studied 78 preterm infants: 31 without brain injury and 47 with brain injury (29 with mild and 18 with moderate-severe injury). Global CBF showed a borderline significant increase with increasing gestational age at birth (P = .05) and trended lower in preterm infants with brain injury (P = .07). Similarly, regional CBF was significantly lower in the right thalamus and midpons (P < .05) and trended lower in the midtemporal, left thalamus, and anterior vermis regions (P < .1) in preterm infants with brain injury. Regional CBF in preterm infants with moderate-severe brain injury trended lower in the midpons, right cerebellar hemisphere, and dentate nuclei compared with mild brain injury (P < .1). In addition, a significant, lower regional CBF was associated with ventilation, sepsis, and cesarean delivery (P < .05). CONCLUSIONS We report early disturbances in global and regional CBF in preterm infants following brain injury. Regional cerebral perfusion alterations were evident in the thalamus and pons, suggesting regional vulnerability of the developing cerebro-cerebellar circuitry.
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Affiliation(s)
- E S Mahdi
- From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology
| | - M Bouyssi-Kobar
- From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology
- Department of Neurology (T.C.)
| | - M B Jacobs
- Department of Epidemiology and Biostatistics (M.B.J.), Children's Research Institute, Children's National Health System, Washington, DC
| | - J Murnick
- From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology
| | - T Chang
- Department of Neurology (T.C.)
| | - C Limperopoulos
- From the Developing Brain Research Program (E.S.M., M.B.-K., J.M., C.L.), Department of Diagnostic Imaging and Radiology
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32
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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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33
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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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34
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Mahmoudzadeh M, Dehaene-Lambertz G, Kongolo G, Fournier M, Goudjil S, Wallois F. Consequence of intraventricular hemorrhage on neurovascular coupling evoked by speech syllables in preterm neonates. Dev Cogn Neurosci 2018; 30:60-69. [PMID: 29328980 PMCID: PMC6969131 DOI: 10.1016/j.dcn.2018.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 11/17/2017] [Accepted: 01/04/2018] [Indexed: 11/12/2022] Open
Abstract
Cerebral hemodynamic response is unable to adapt to exogenous stimulation in IVH preterms. EEG–NIRS coregistration allows to obtain high temporal and spatial resolution measurements in preterm neonates. Optical imaging identifies pathological cerebral hemodynamics.
Intraventricular Hemorrhage (IVH) is the leading cause of neurological and cognitive impairment in preterm neonates with an incidence that increases with increasing prematurity. In the present study, we tested how preterm neonates with IVH react to external stimulation (i.e. speech syllables). We compared their neural responses measured by electroencephalography (EEG), and hemodynamic responses measured by functional near-infrared spectroscopy (fNIRS), with those of healthy preterms. A neural response to syllables was observed in these infants, but did not induce a vascular response in contrast with healthy neonates. These results clearly demonstrate that the cerebral vascular network in IVH preterm neonates was unable to compensate for the increased metabolism resulting from neuronal activation in response to external stimulation. Optical imaging is thus a sensitive tool to identify altered cerebral hemodynamic in critically ill preterms before behavioral changes are manifested or when only minor abnormalities on other functional monitoring techniques such as EEG are visible. We propose that a multi-modal approach provides unique opportunities for early monitoring of cognitive functions and opens up new possibilities for clinical care and recommended practices by studying the difficulties of the premature brain to adapt to its environment.
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Affiliation(s)
- Mahdi Mahmoudzadeh
- INSERM U1105, Université de Picardie, CURS, Amiens, France; INSERM U1105, Unit Exploration Fonctionnelles du Système Nerveux Pédiatrique, South University Hospital, Amiens, France.
| | - 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, Neonatal ICU, South University Hospital, Amiens, France
| | - Marc Fournier
- INSERM U1105, Université de Picardie, CURS, Amiens, France
| | - Sabrina Goudjil
- 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
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Chiarelli AM, Zappasodi F, Di Pompeo F, Merla A. Simultaneous functional near-infrared spectroscopy and electroencephalography for monitoring of human brain activity and oxygenation: a review. NEUROPHOTONICS 2017; 4:041411. [PMID: 28840162 PMCID: PMC5566595 DOI: 10.1117/1.nph.4.4.041411] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/24/2017] [Indexed: 05/24/2023]
Abstract
Multimodal monitoring has become particularly common in the study of human brain function. In this context, combined, synchronous measurements of functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) are getting increased interest. Because of the absence of electro-optical interference, it is quite simple to integrate these two noninvasive recording procedures of brain activity. fNIRS and EEG are both scalp-located procedures. fNIRS estimates brain hemodynamic fluctuations relying on spectroscopic measurements, whereas EEG captures the macroscopic temporal dynamics of brain electrical activity through passive voltages evaluations. The "orthogonal" neurophysiological information provided by the two technologies and the increasing interest in the neurovascular coupling phenomenon further encourage their integration. This review provides, together with an introduction regarding the principles and future directions of the two technologies, an evaluation of major clinical and nonclinical applications of this flexible, low-cost combination of neuroimaging modalities. fNIRS-EEG systems exploit the ability of the two technologies to be conducted in an environment or experimental setting and/or on subjects that are generally not suited for other neuroimaging modalities, such as functional magnetic resonance imaging, positron emission tomography, and magnetoencephalography. fNIRS-EEG brain monitoring settles itself as a useful multimodal tool for brain electrical and hemodynamic activity investigation.
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Affiliation(s)
- Antonio M. Chiarelli
- University of Illinois at Urbana Champaign, Beckman Institute, Urbana, Illinois, United States
| | - Filippo Zappasodi
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
| | - Francesco Di Pompeo
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
| | - Arcangelo Merla
- Università G. d’Annunzio, Department of Neuroscience, Imaging and Clinical Science, Chieti, Italy
- Università G. d’Annunzio, Institute for Advanced Biomedical Technologies, Chieti, Italy
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Shang Y, Li T, Yu G. Clinical applications of near-infrared diffuse correlation spectroscopy and tomography for tissue blood flow monitoring and imaging. Physiol Meas 2017; 38:R1-R26. [PMID: 28199219 PMCID: PMC5726862 DOI: 10.1088/1361-6579/aa60b7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Blood flow is one such available observable promoting a wealth of physiological insight both individually and in combination with other metrics. APPROACH Near-infrared diffuse correlation spectroscopy (DCS) and, to a lesser extent, diffuse correlation tomography (DCT), have increasingly received interest over the past decade as noninvasive methods for tissue blood flow measurements and imaging. DCS/DCT offers several attractive features for tissue blood flow measurements/imaging such as noninvasiveness, portability, high temporal resolution, and relatively large penetration depth (up to several centimeters). MAIN RESULTS This review first introduces the basic principle and instrumentation of DCS/DCT, followed by presenting clinical application examples of DCS/DCT for the diagnosis and therapeutic monitoring of diseases in a variety of organs/tissues including brain, skeletal muscle, and tumor. SIGNIFICANCE Clinical study results demonstrate technical versatility of DCS/DCT in providing important information for disease diagnosis and intervention monitoring.
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Affiliation(s)
- Yu Shang
- Key Laboratory of Instrumentation Science & Dynamic Measurement, North University of China, No.3 Xueyuan Road, Taiyuan, Shanxi 030051, China
| | - Ting Li
- State Key Lab Elect Thin Film & Integrated Device, University of Electronic Science & Technology of China, Chengdu, Sichuan 610054, China
| | - Guoqiang Yu
- Department of Biomedical Engineering, University of Kentucky, 514C RMB, 143 Graham Avenue, Lexington, KY 40506-0108, USA
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Zouaoui J, Di Sieno L, Hervé L, Pifferi A, Farina A, Mora AD, Derouard J, Dinten JM. Quantification in time-domain diffuse optical tomography using Mellin-Laplace transforms. BIOMEDICAL OPTICS EXPRESS 2016; 7:4346-4363. [PMID: 27867736 PMCID: PMC5102524 DOI: 10.1364/boe.7.004346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/14/2016] [Accepted: 08/28/2016] [Indexed: 05/21/2023]
Abstract
Simulations and phantom measurements are used to evaluate the ability of time-domain diffuse optical tomography using Mellin-Laplace transforms to quantify the absorption perturbation of centimetric objects immersed at depth 1-2 cm in turbid media. We find that the estimated absorption coefficient varies almost linearly with the absorption change in the range of 0-0.15 cm-1 but is underestimated by a factor that depends on the inclusion depth (~2, 3 and 6 for depths of 1.0, 1.5 and 2.0 cm respectively). For larger absorption changes, the variation is sublinear with ~20% decrease for δμa = 0.37 cm-1. By contrast, constraining the absorption change to the actual volume of the inclusion may considerably improve the accuracy and linearity of the reconstructed absorption.
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Affiliation(s)
- Judy Zouaoui
- Univ. Grenoble Alpes, F-38000 Grenoble, France CEA, LETI, MINATEC Campus, F-38054 Grenoble, France
| | - Laura Di Sieno
- Politecnico di Milano, Dipartimento di Fisica, Piazza Leonardo da Vinci 32, Milano I-20133, Italy
| | - Lionel Hervé
- Univ. Grenoble Alpes, F-38000 Grenoble, France CEA, LETI, MINATEC Campus, F-38054 Grenoble, France
| | - Antonio Pifferi
- Politecnico di Milano, Dipartimento di Fisica, Piazza Leonardo da Vinci 32, Milano I-20133, Italy
| | - Andrea Farina
- Politecnico di Milano, Dipartimento di Fisica, Piazza Leonardo da Vinci 32, Milano I-20133, Italy
| | - Alberto Dalla Mora
- Politecnico di Milano, Dipartimento di Fisica, Piazza Leonardo da Vinci 32, Milano I-20133, Italy
| | | | - Jean-Marc Dinten
- Univ. Grenoble Alpes, F-38000 Grenoble, France CEA, LETI, MINATEC Campus, F-38054 Grenoble, France
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