Assessment of infant brain development with frequency-domain near-infrared spectroscopy

Individualized post-operative prediction of cochlear implantation outcomes in children with prelingual deafness using functional near-infrared spectroscopy

Objective

The goal of this study was to develop an objective measure and predictor of cochlear implantation (CI) outcomes using functional near-infrared spectroscopy (fNIRS) for young children with prelingual deafness.

Methods

Sound-evoked hemodynamic responses were recorded from auditory and language-related cortical regions of 47 child CI recipients (35.47 ± 17.24 months of age) using fNIRS shortly after CI activation (0.26 ± 0.30 months). There were four sound conditions (natural speech, instrumental music, multi-speaker babble noise, and speech-in-noise). Post-CI auditory and verbal communication performance was evaluated using clinical questionnaires with caretakers. Both classification and individualized regression models were constructed to predict post-CI behavioral improvement from fNIRS data using support vector machine (SVM) learning algorithms.

Results

Auditory cortical responses shortly after CI hearing onset yielded highly accurate prediction of behavioral development in young CI children. For classification models, optimal prediction was achieved using cortical responses to two or more sound conditions, with the highest accuracy of 98.20% (precision = 98.17%, sensitivity = 98.96%, area under the curve of the receiver operating characteristic curve = 99.61%) obtained with the combination of speech, noise, and music stimuli. Similarly, for regression models, best prediction of individual development was achieved using three (highest r = 0.919) or four (r = 0.966) sound conditions. The predictability of cortical responses far outperformed (Cohen's d: 18.56) that of the collection of audiological and demographic parameters (classification accuracy: 0.62) under the same SVM algorithms and could not benefit from the inclusion of the latter.

Conclusion

Machine learning models using auditory cortical hemodynamic responses shortly after CI activation were able to predict individualized post-CI behavioral improvement in children with prelingual deafness.

Level of Evidence

Level 5.

Mapping neural correlates of biological motion perception in autistic children using high-density diffuse optical tomography

BACKGROUND

Autism spectrum disorder (ASD), a neurodevelopmental disorder defined by social communication deficits plus repetitive behaviors and restricted interests, currently affects 1/36 children in the general population. Recent advances in functional brain imaging show promise to provide useful biomarkers of ASD diagnostic likelihood, behavioral trait severity, and even response to therapeutic intervention. However, current gold-standard neuroimaging methods (e.g., functional magnetic resonance imaging, fMRI) are limited in naturalistic studies of brain function underlying ASD-associated behaviors due to the constrained imaging environment. Compared to fMRI, high-density diffuse optical tomography (HD-DOT), a non-invasive and minimally constraining optical neuroimaging modality, can overcome these limitations. Herein, we aimed to establish HD-DOT to evaluate brain function in autistic and non-autistic school-age children as they performed a biological motion perception task previously shown to yield results related to both ASD diagnosis and behavioral traits.

METHODS

We used HD-DOT to image brain function in 46 ASD school-age participants and 49 non-autistic individuals (NAI) as they viewed dynamic point-light displays of coherent biological and scrambled motion. We assessed group-level cortical brain function with statistical parametric mapping. Additionally, we tested for brain-behavior associations with dimensional metrics of autism traits, as measured with the Social Responsiveness Scale-2, with hierarchical regression models.

RESULTS

We found that NAI participants presented stronger brain activity contrast (coherent > scrambled) than ASD children in cortical regions related to visual, motor, and social processing. Additionally, regression models revealed multiple cortical regions in autistic participants where brain function is significantly associated with dimensional measures of ASD traits.

LIMITATIONS

Optical imaging methods are limited in depth sensitivity and so cannot measure brain activity within deep subcortical regions. However, the field of view of this HD-DOT system includes multiple brain regions previously implicated in both task-based and task-free studies on autism.

CONCLUSIONS

This study demonstrates that HD-DOT is sensitive to brain function that both differentiates between NAI and ASD groups and correlates with dimensional measures of ASD traits. These findings establish HD-DOT as an effective tool for investigating brain function in autistic and non-autistic children. Moreover, this study established neural correlates related to biological motion perception and its association with dimensional measures of ASD traits.

Changes in regional tissue oxygen saturation values during the first week of life in stable preterm infants

OBJECTIVES

Near infrared spectroscopy (NIRS) is a non-invasive method for monitoring regional tissue oxygen saturation (rSO2). The purpose of this study is to investigate the changes that occur in cerebral, splanchnic, and renal rSO2 and fractional tissue oxygen extraction (FTOE) in stable preterm infants in the first week of life.

METHODS

Prospective observational study of infants born 30-34 weeks gestation at NYU Langone Health between November 2017 and November 2018. Cerebral, renal, and splanchnic rSO2 were monitored from 12 to 72 h of life, and at seven days. Subjects were divided into gestational age (GA) cohorts. Average rSO2, splanchnic cerebral oxygen ratio (SCOR), FTOE, and regional intra-subject variability was calculated at each location at five different time intervals: 0-12 h, 12-24 h, 24-48 h, 48-72 h, and one week of life.

RESULTS

Twenty subjects were enrolled. The average cerebral rSO2 ranged from 76.8 to 92.8 %, renal rSO2 from 65.1 to 91.1 %, and splanchnic rSO2 from 36.1 to 76.3 %. The SCOR ranged from 0.45 to 0.94. The strongest correlation between the GA cohorts was in the cerebral region (R2=0.94) and weakest correlation was in the splanchnic region (R2=0.81). The FTOE increased in all three locations over time. Intra-subject variability was lowest in the cerebral region (1.3 % (±1.9)).

CONCLUSIONS

The cerebral region showed the strongest correlation between GA cohorts and lowest intra-subject variability, making it the most suitable for clinical use when monitoring for tissue hypoxia. Further studies are needed to further examine rSO2 in preterm infants.

Simultaneous assessment of blood flow and myelin content in the brain white matter with dynamic [11 C]PiB PET: a test-retest study in healthy controls

BACKGROUND

Exploring the relationship between oxygen supply and myelin damage would benefit from a simultaneous quantification of myelin and cerebral blood flow (CBF) in the brain's white matter (WM). To validate an analytical method for quantifying both CBF and myelin content in the WM using dynamic [11C]PiB positron emission tomography (PET).

METHODS

A test-retest study was performed on eight healthy subjects who underwent two consecutive dynamic [11 C]PiB-PET scans. Three quantitative approaches were compared: simplified reference tissue model 2 (SRTM2), LOGAN graphical model, and standardized uptake value ratio (SUVR). The sensitivity of methods to the size of the region of interest was explored by simulating lesion masks obtained from 36 subjects with multiple sclerosis. Reproducibility was assessed using the relative difference and interclass correlation coefficient. Repeated measures correlations were used to test for cross-correlations between metrics.

RESULTS

Among the CBF measures, the relative delivery (R1) of the simplified reference tissue model 2 (SRTM2) displayed the best reproducibility in the white matter, with a strong influence of the size of regions analyzed, the test-retest variability being below 10% for regions above 68 mm3 in the supratentorial white matter. [11C]PiB PET-derived proxies of CBF demonstrated lower perfusion of white matter compared to grey matter with an overall ratio equal to 1.71 ± 0.09 when the SRTM2-R1 was employed. Tissue binding in the white matter was well estimated by the Logan graphical model through estimation of the distribution volume ratio (LOGAN-DVR) and SRTM2 distribution volume ratio (SRTM2-DVR), with test-retest variability being below 10% for regions exceeding 106 mm3 for LOGAN-DVR and 300 mm3 for SRTM2-DVR. SRTM2-DVR provided a better contrast between white matter and grey matter. The interhemispheric variability was also dependent on the size of the region analyzed, being below 10% for regions above 103 mm3 for SRTM2-R1 and above 110 mm3 for LOGAN-DVR. Whereas the 1 to 8-minute standardized uptake value ratio (SUVR1-8) showed an intermediary reproducibility for CBF assessment, SUVR0-2 for perfusion or SUVR50-70 for tissue binding showed poor reproducibility and correlated only mildly with SRTM2-R1 and LOGAN-DVR estimations respectively.

CONCLUSIONS

[11C]PiB PET imaging can simultaneously quantify perfusion and myelin content in WM diseases associated with focal lesions. For longitudinal studies, SRTM2-R1 and DVR should be preferred over SUVR for the assessment of regional CBF and myelin content, respectively.

TRIAL REGISTRATION

European Union Clinical Trials Register EUDRACT; EudraCT Number: 2008-004174-40; Date: 2009-03-06; https//www.clinicaltrialsregister.eu ; number 2008-004174-40.

Transformer based multi-modal MRI fusion for prediction of post-menstrual age and neonatal brain development analysis

The brain development during the perinatal period is characterized by rapid changes in both structure and function, which have significant impact on the cognitive and behavioral abilities later in life. Accurate assessment of brain age is a crucial indicator for brain development maturity and can help predict the risk of neonatal pathology. However, evaluating neonatal brains using magnetic resonance imaging (MRI) is challenging due to its complexity, multi-dimension, and noise with subtle alterations. In this paper, we propose a multi-modal deep learning framework based on transformers for precise post-menstrual age (PMA) estimation and brain development analysis using T2-weighted structural MRI (T2-sMRI) and diffusion MRI (dMRI) data. First, we build a two-stream dense network to learn modality-specific features from T2-sMRI and dMRI of brain individually. Then, a transformer module based on self-attention mechanism integrates these features for PMA prediction and preterm/term classification. Finally, saliency maps on brain templates are used to enhance the interpretability of results. Our method is evaluated on the multi-modal MRI dataset of the developing Human Connectome Project (dHCP), which contains 592 neonates, including 478 term-born and 114 preterm-born subjects. The results demonstrate that our method achieves a 0.5-week mean absolute error (MAE) in PMA estimation for term-born subjects. Notably, preterm-born subjects exhibit delayed brain development, worsening with increasing prematurity. Our method also achieves 95% accuracy in classification of term-born and preterm-born subjects, revealing significant group differences.

The use of functional near-infrared spectroscopy in tracking neurodevelopmental trajectories in infants and children with or without developmental disorders: a systematic review

Understanding the neurodevelopmental trajectories of infants and children is essential for the early identification of neurodevelopmental disorders, elucidating the neural mechanisms underlying the disorders, and predicting developmental outcomes. Functional Near-Infrared Spectroscopy (fNIRS) is an infant-friendly neuroimaging tool that enables the monitoring of cerebral hemodynamic responses from the neonatal period. Due to its advantages, fNIRS is a promising tool for studying neurodevelopmental trajectories. Although many researchers have used fNIRS to study neural development in infants/children and have reported important findings, there is a lack of synthesized evidence for using fNIRS to track neurodevelopmental trajectories in infants and children. The current systematic review summarized 84 original fNIRS studies and showed a general trend of age-related increase in network integration and segregation, interhemispheric connectivity, leftward asymmetry, and differences in phase oscillation during resting-state. Moreover, typically developing infants and children showed a developmental trend of more localized and differentiated activation when processing visual, auditory, and tactile information, suggesting more mature and specialized sensory networks. Later in life, children switched from recruiting bilateral auditory to a left-lateralized language circuit when processing social auditory and language information and showed increased prefrontal activation during executive functioning tasks. The developmental trajectories are different in children with developmental disorders, with infants at risk for autism spectrum disorder showing initial overconnectivity followed by underconnectivity during resting-state; and children with attention-deficit/hyperactivity disorders showing lower prefrontal cortex activation during executive functioning tasks compared to their typically developing peers throughout childhood. The current systematic review supports the use of fNIRS in tracking the neurodevelopmental trajectories in children. More longitudinal studies are needed to validate the neurodevelopmental trajectories and explore the use of these neurobiomarkers for the early identification of developmental disorders and in tracking the effects of interventions.

Spatial-Temporal Oxygenation Mapping Using a Near-Infrared Optical Scanner: Towards Peripheral Vascular Imaging

Near-infrared spectroscopy (NIRS)-based peripheral perfusion, or microcirculation, can be used to assess the severity of peripheral vascular dysfunction. A low-cost, portable non-contact near-infrared optical scanner (NIROS) was developed for spatio-temporal mapping of tissue oxygenation and perfusion in tissues. In vivo validation studies were carried out on control subjects (n = 3) to assess the ability of NIROS to measure real-time oxygenation changes in response to an occlusion paradigm on the dorsum of the hand. NIROS captured real-time tissue oxygenation changes with 95% correlation when compared to a commercial device. A feasibility peripheral imaging study was performed in a mouse model (n = 5) of chronic kidney disease (CKD) induced vascular calcification to assess differences in microcirculatory peripheral tissue oxygenation. The tissue oxygenation (in terms of oxy-, deoxy-, and total hemoglobin changes) due to the occlusion paradigm was distinctly different prior to (week-6) and after the onset of vascular calcification (week-12) in the murine tails. Future work will involve extensive studies to correlate these microcirculatory tissue oxygenation changes in the peripheral tail to the vascular calcification in the heart.

Review of recent advances in frequency-domain near-infrared spectroscopy technologies [Invited]

Over the past several decades, near-infrared spectroscopy (NIRS) has become a popular research and clinical tool for non-invasively measuring the oxygenation of biological tissues, with particular emphasis on applications to the human brain. In most cases, NIRS studies are performed using continuous-wave NIRS (CW-NIRS), which can only provide information on relative changes in chromophore concentrations, such as oxygenated and deoxygenated hemoglobin, as well as estimates of tissue oxygen saturation. Another type of NIRS known as frequency-domain NIRS (FD-NIRS) has significant advantages: it can directly measure optical pathlength and thus quantify the scattering and absorption coefficients of sampled tissues and provide direct measurements of absolute chromophore concentrations. This review describes the current status of FD-NIRS technologies, their performance, their advantages, and their limitations as compared to other NIRS methods. Significant landmarks of technological progress include the development of both benchtop and portable/wearable FD-NIRS technologies, sensitive front-end photonic components, and high-frequency phase measurements. Clinical applications of FD-NIRS technologies are discussed to provide context on current applications and needed areas of improvement. The review concludes by providing a roadmap toward the next generation of fully wearable, low-cost FD-NIRS systems.

Age-dependent neurovascular coupling characteristics in children and adults during general anesthesia

General anesthesia is an indispensable procedure in clinical practice. Anesthetic drugs induce dramatic changes in neuronal activity and cerebral metabolism. However, the age-related changes in neurophysiology and hemodynamics during general anesthesia remain unclear. Therefore, the objective of this study was to explore the neurovascular coupling between neurophysiology and hemodynamics in children and adults during general anesthesia. We analyzed frontal electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) signals recorded from children (6-12 years old, n = 17) and adults (18-60 years old, n = 25) during propofol-induced and sevoflurane-maintained general anesthesia. The neurovascular coupling was evaluated in wakefulness, maintenance of a surgical state of anesthesia (MOSSA), and recovery by using correlation, coherence and Granger-causality (GC) between the EEG indices [EEG power in different bands and permutation entropy (PE)], and hemodynamic responses the oxyhemoglobin (Δ[HbO]) and deoxy-hemoglobin (Δ[Hb]) from fNIRS in the frequency band in 0.01-0.1 Hz. The PE and Δ[Hb] performed well in distinguishing the anesthesia state (p > 0.001). The correlation between PE and Δ[Hb] was higher than those of other indices in the two age groups. The coherence significantly increased during MOSSA (p < 0.05) compared with wakefulness, and the coherences between theta, alpha and gamma, and hemodynamic activities of children are significantly stronger than that of adults' bands. The GC from neuronal activities to hemodynamic responses decreased during MOSSA, and can better distinguish anesthesia state in adults. Propofol-induced and sevoflurane-maintained combination exhibited age-dependent neuronal activities, hemodynamics, and neurovascular coupling, which suggests the need for separate rules for children's and adults' brain states monitoring during general anesthesia.

Differential auditory cortical development in left and right cochlear implanted children

Unilateral aural stimulation has been shown to cause massive cortical reorganization in brain with congenital deafness, particularly during the sensitive period of brain development. However, it is unclear which side of stimulation provides most advantages for auditory development. The left hemisphere dominance of speech and linguistic processing in normal hearing adult brain has led to the assumption of functional and developmental advantages of right over left implantation, but existing evidence is controversial. To test this assumption and provide evidence for clinical choice, we examined 34 prelingually deaf children with unilateral cochlear implants using near-infrared spectroscopy. While controlling for age of implantation, residual hearing, and dominant hand, cortical processing of speech showed neither developmental progress nor influence of implantation side weeks to months after implant activation. In sharp contrast, for nonspeech (music signal vs. noise) processing, left implantation showed functional advantages over right implantation that were not yet discernable using clinical, questionnaire-based outcome measures. These findings support the notion that the right hemisphere develops earlier and is better preserved from adverse environmental influences than its left counterpart. This study thus provides, to our knowledge, the first evidence for differential influences of left and right auditory peripheral stimulation on early cortical development of the human brain.

Transcranial optical monitoring for detecting intracranial pressure alterations in children with benign external hydrocephalus: a proof-of-concept study

SIGNIFICANCE

Benign external hydrocephalus (BEH) is considered a self-limiting pathology with a good prognosis. However, some children present a pathological intracranial pressure (ICP) characterized by quantitative and qualitative alterations (the so-called B-waves) that can lead to neurological sequelae.

AIM

Our purpose was to evaluate whether there were cerebral hemodynamic changes associated with ICP B-waves that could be evaluated with noninvasive neuromonitoring.

APPROACH

We recruited eleven patients (median age 16 months, range 7 to 55 months) with BEH and an unfavorable evolution requiring ICP monitoring. Bedside, nocturnal monitoring using near-infrared time-resolved and diffuse correlation spectroscopies synchronized to the clinical monitoring was performed.

RESULTS

By focusing on the timing of different ICP patterns that were identified manually by clinicians, we detected significant tissue oxygen saturation ( StO 2 ) changes ( p = 0.002 ) and blood flow index (BFI) variability ( p = 0.005 ) between regular and high-amplitude B-wave patterns. A blinded analysis looking for analogs of ICP patterns in BFI time traces achieved 90% sensitivity in identifying B-waves and 76% specificity in detecting the regular patterns.

CONCLUSIONS

We revealed the presence of StO 2 and BFI variations-detectable with optical techniques-during ICP B-waves in BEH children. Finally, the feasibility of detecting ICP B-waves in hemodynamic time traces obtained noninvasively was shown.

Clinical significance of assessing cerebral blood volume by time-domain near-infrared spectroscopy in children with congenital heart disease

BACKGROUND

Despite providing cerebral tissue oxygen saturation (StO₂ ), the lack of quantitative information for continuous wave near-infrared spectroscopy (CW-NIRS) is an obstacle in evaluating cerebral hemodynamic conditions. Time-domain NIRS (TD-NIRS) provides both StO₂ and cerebral blood volume and has recently become clinically available.

AIM

To investigate if the additional monitoring of cerebral blood volume by TD-NIRS facilitates the understanding of cerebral hemodynamic conditions in patients with congenital heart disease.

METHODS

Preoperative TD-NIRS values were retrospectively reviewed in patients who underwent a cardiac surgery or catheter examination. We compared the values between patients with single and two ventricles. Moreover, we investigated the association of these values with the demographic and clinical variables.

RESULTS

There was no significant difference in StO2 between single ventricle and two ventricles groups (median: 59.9 vs. 54.4, median difference [95% CI]: -4.06 [-9.90 to 2.90], p = .37). However, cerebral blood volume was significantly higher in the single ventricle group (median: 4.68 vs. 2.84, median difference [95% CI]: -2.01 [-2.88 to -1.06], p < .001). Spearman's rank correlation analysis demonstrated an association between StO2 and postmenstrual age (r = 0.35, p = .03). In contrast, cerebral blood volume was correlated with single ventricle physiology (r = 0.62, p < .001), postmenstrual age (r = 0.74, p < .001), central venous pressure (r = 0.38, p = .02), and SaO2 (r = -0.38, p = .02). The multivariable regression analysis identified the postmenstrual age, single ventricle physiology, and SaO2 as independent factors associated with cerebral blood volume. In the logistic analysis, cerebral blood volume was identified as a significant predictor of unfavorable conditions.

CONCLUSION

Cerebral blood volume monitoring detected differences in cerebral hemodynamic conditions, related to the age and the type of ventricle physiologies. However, the differences were not apparent in StO₂ . The additional monitoring of cerebral blood volume by TD-NIRS would facilitate a better understanding of cerebral hemodynamic conditions in patients with congenital heart disease.

Imaging affective and non-affective touch processing in two-year-old children

Touch is an important component of early parent-child interaction and plays a critical role in the socio-emotional development of children. However, there are limited studies on touch processing amongst children in the age range from one to three years. The present study used frequency-domain diffuse optical tomography (DOT) to investigate the processing of affective and non-affective touch over left frontotemporal brain areas contralateral to the stimulated forearm in two-year-old children. Affective touch was administered by a single stroke with a soft brush over the child's right dorsal forearm at 3 cm/s, while non-affective touch was provided by multiple brush strokes at 30 cm/s. We found that in the insula, the total haemoglobin (HbT) response to slow brushing was significantly greater than the response to fast brushing (slow > fast). Additionally, a region in the postcentral gyrus, Rolandic operculum and superior temporal gyrus exhibited greater response to fast brushing than slow brushing (fast > slow). These findings confirm that an adult-like pattern of haemodynamic responses to affective and non-affective touch can be recorded in two-year-old subjects using DOT. To improve the accuracy of modelling light transport in the two-year-old subjects, we used a published age-appropriate atlas and deformed it to match the exterior shape of each subject's head. We estimated the combined scalp and skull, and grey matter (GM) optical properties by fitting simulated data to calibrated and coupling error corrected phase and amplitude measurements. By utilizing a two-compartment cerebrospinal fluid (CSF) model, the accuracy of estimation of GM optical properties and the localization of activation in the insula was improved. The techniques presented in this paper can be used to study neural development of children at different ages and illustrate that the technology is well-tolerated by most two-year-old children and not excessively sensitive to subject movement. The study points the way towards exciting possibilities in functional imaging of deeper functional areas near sulci in small children.

Regional Haemodynamic and Metabolic Coupling in Infants

Metabolic pathways underlying brain function remain largely unexplored during neurodevelopment, predominantly due to the lack of feasible techniques for use with awake infants. Broadband near-infrared spectroscopy (bNIRS) provides the opportunity to explore the relationship between cerebral energy metabolism and blood oxygenation/haemodynamics through the measurement of changes in the oxidation state of mitochondrial respiratory chain enzyme cytochrome-c-oxidase (ΔoxCCO) alongside haemodynamic changes. We used a bNIRS system to measure ΔoxCCO and haemodynamics during functional activation in a group of 42 typically developing infants aged between 4 and 7 months. bNIRS measurements were made over the right hemisphere over temporal, parietal and central cortical regions, in response to social and non-social visual and auditory stimuli. Both ΔoxCCO and Δ[HbO2] displayed larger activation for the social condition in comparison to the non-social condition. Integration of haemodynamic and metabolic signals revealed networks of stimulus-selective cortical regions that were not apparent from analysis of the individual bNIRS signals. These results provide the first spatially resolved measures of cerebral metabolic activity alongside haemodynamics during functional activation in infants. Measuring synchronised changes in metabolism and haemodynamics have the potential for uncovering the development of cortical specialisation in early infancy.

Imaging Cerebral Energy Metabolism in Healthy Infants

Broadband near-infrared spectroscopy (bNIRS) has the potential to provide non-invasive measures of cerebral haemodynamic changes alongside changes in cellular oxygen utilisation through the measurement of mitochondrial enzyme cytochrome-c-oxidase (oxCCO). It therefore provides the opportunity to explore brain function and specialisation, which remains largely unexplored in infancy. We used bNIRS to measure changes in haemodynamics and changes in oxCCO in 4-to-7-month-old infants over the occipital and right temporal and parietal cortices in response to social and non-social visual and auditory stimuli. Changes in concentration of oxygenated-haemoglobin (Δ[HbO₂]), deoxygenated haemoglobin (Δ[HHb]) and change in the oxidation state of oxCCO (Δ[oxCCO]) were calculated using changes in attenuation of light at 120 wavelengths between 780 and900 nm, using the UCLn algorithm. For 4 infants, the attenuation changes in a subset of wavelengths were used to perform image reconstruction, in an age-matched infant model, for channels over the right parietal and temporal cortices, using a multispectral approach which allows direct reconstruction of concentration change data. The volumetric reconstructed images were mapped onto the cortical surface to visualise the reconstructed changes in concentration of HbO₂ and HHb and changes in metabolism for both social and non-social stimuli. Spatially localised activation was observed for Δ[oxCCO] and Δ[HbO₂] over the temporo-parietal region, in response to the social stimulus. This study provides the first reconstructed images of changes in metabolism in healthy, awake infants.

Quantitative Changes in Muscular and Capillary Oxygen Desaturation Measured by Optical Sensors during Continuous Positive Airway Pressure Titration for Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common sleep disorder, and continuous positive airway pressure (CPAP) is the most effective treatment. Poor adherence is one of the major challenges in CPAP therapy. The recent boom of wearable optical sensors measuring oxygen saturation makes at-home multiple-night CPAP titrations possible, which may essentially improve the adherence of CPAP therapy by optimizing its pressure in a real-life setting economically. We tested whether the oxygen desaturations (ODs) measured in the arm muscle (arm_OD) by gold-standard frequency-domain multi-distance near-infrared spectroscopy (FDMD-NIRS) change quantitatively with titrated CPAP pressures in OSA patients together with polysomnography. We found that the arm_OD (2.08 ± 1.23%, mean ± standard deviation) was significantly smaller (p-value < 0.0001) than the fingertip OD (finger_OD) (4.46 ± 2.37%) measured by a polysomnography pulse oximeter. Linear mixed-effects models suggested that CPAP pressure was a significant predictor for finger_OD but not for arm_OD. Since FDMD-NIRS measures a mixture of arterial and venous OD, whereas a fingertip pulse oximeter measures arterial OD, our results of no association between arm_OD and finger_OD indicate that the arm_OD mainly represented venous desaturation. Arm_OD measured by optical sensors used for wearables may not be a suitable indicator of the CPAP titration effectiveness.

Regulation of the Cerebral Circulation During Development

The cerebral microcirculation undergoes dynamic changes in parallel with the development of neurons, glia, and their energy metabolism throughout gestation and postnatally. Cerebral blood flow (CBF), oxygen consumption, and glucose consumption are as low as 20% of adult levels in humans born prematurely but eventually exceed adult levels at ages 3 to 11 years, which coincide with the period of continued brain growth, synapse formation, synapse pruning, and myelination. Neurovascular coupling to sensory activation is present but attenuated at birth. By 2 postnatal months, the increase in CBF often is disproportionately smaller than the increase in oxygen consumption, in contrast to the relative hyperemia seen in adults. Vascular smooth muscle myogenic tone increases in parallel with developmental increases in arterial pressure. CBF autoregulatory response to increased arterial pressure is intact at birth but has a more limited range with arterial hypotension. Hypoxia-induced vasodilation in preterm fetal sheep with low oxygen consumption does not sustain cerebral oxygen transport, but the response becomes better developed for sustaining oxygen transport by term. Nitric oxide tonically inhibits vasomotor tone, and glutamate receptor activation can evoke its release in lambs and piglets. In piglets, astrocyte-derived carbon monoxide plays a central role in vasodilation evoked by glutamate, ADP, and seizures, and prostanoids play a large role in endothelial-dependent and hypercapnic vasodilation. Overall, homeostatic mechanisms of CBF regulation in response to arterial pressure, neuronal activity, carbon dioxide, and oxygenation are present at birth but continue to develop postnatally as neurovascular signaling pathways are dynamically altered and integrated. © 2021 American Physiological Society. Compr Physiol 11:1-62, 2021.

The Challenges and Pitfalls of Detecting Sleep Hypopnea Using a Wearable Optical Sensor: Comparative Study

Background

Obstructive sleep apnea (OSA) is the most prevalent respiratory sleep disorder occurring in 9% to 38% of the general population. About 90% of patients with suspected OSA remain undiagnosed due to the lack of sleep laboratories or specialists and the high cost of gold-standard in-lab polysomnography diagnosis, leading to a decreased quality of life and increased health care burden in cardio- and cerebrovascular diseases. Wearable sleep trackers like smartwatches and armbands are booming, creating a hope for cost-efficient at-home OSA diagnosis and assessment of treatment (eg, continuous positive airway pressure [CPAP] therapy) effectiveness. However, such wearables are currently still not available and cannot be used to detect sleep hypopnea. Sleep hypopnea is defined by ≥30% drop in breathing and an at least 3% drop in peripheral capillary oxygen saturation (Spo₂) measured at the fingertip. Whether the conventional measures of oxygen desaturation (OD) at the fingertip and at the arm or wrist are identical is essentially unknown.

Objective

We aimed to compare event-by-event arm OD (arm_OD) with fingertip OD (finger_OD) in sleep hypopneas during both naïve sleep and CPAP therapy.

Methods

Thirty patients with OSA underwent an incremental, stepwise CPAP titration protocol during all-night in-lab video-polysomnography monitoring (ie, 1-h baseline sleep without CPAP followed by stepwise increments of 1 cmH₂O pressure per hour starting from 5 to 8 cmH₂O depending on the individual). Arm_OD of the left biceps muscle and finger_OD of the left index fingertip in sleep hypopneas were simultaneously measured by frequency-domain near-infrared spectroscopy and video-polysomnography photoplethysmography, respectively. Bland-Altman plots were used to illustrate the agreements between arm_OD and finger_OD during baseline sleep and under CPAP. We used t tests to determine whether these measurements significantly differed.

Results

In total, 534 obstructive apneas and 2185 hypopneas were recorded. Of the 2185 hypopneas, 668 (30.57%) were collected during baseline sleep and 1517 (69.43%), during CPAP sleep. The mean difference between finger_OD and arm_OD was 2.86% (95% CI 2.67%-3.06%, t₆₆₇=28.28; P<.001; 95% limits of agreement [LoA] –2.27%, 8.00%) during baseline sleep and 1.83% (95% CI 1.72%-1.94%, t₁₅₁₆=31.99; P<.001; 95% LoA –2.54%, 6.19%) during CPAP. Using the standard criterion of 3% saturation drop, arm_OD only recognized 16.32% (109/668) and 14.90% (226/1517) of hypopneas at baseline and during CPAP, respectively.

Conclusions

arm_OD is 2% to 3% lower than standard finger_OD in sleep hypopnea, probably because the measured arm_OD originates physiologically from arterioles, venules, and capillaries; thus, the venous blood adversely affects its value. Our findings demonstrate that the standard criterion of ≥3% OD drop at the arm or wrist is not suitable to define hypopnea because it could provide large false-negative results in diagnosing OSA and assessing CPAP treatment effectiveness.

Tracking Brain Development From Neonates to the Elderly by Hemoglobin Phase Measurement Using Functional Near-Infrared Spectroscopy

The biological and neurological processes during the lifespan are dynamic with significant alterations associated with different stages of life. The phase and coupling of oxy-hemoglobin (Δ[HbO]) and deoxy-hemoglobin concentration changes (Δ[Hb]) measured by functional near-infrared spectroscopy (fNIRS) are shown to characterize the neurovascular and metabolic development of infants. However, the changes in phase and coupling across the human lifespan remain mostly unknown. Here, fNIRS measurements of Δ[HbO] and Δ[Hb] conducted at two sites on different age populations (from newborns to elderly) were combined. Firstly, we assessed the influence of random noise on the calculation of the phase difference and phase-locking index (PLI) in fNIRS measurement. The results showed that the phase difference is close to π as the noise intensity approaches -8 dB, and the coupling strength (i.e., PLI) presents a u-shape curve as the noise increase. Secondly, phase difference and PLI in the frequency range 0.01-0.10 Hz were calculated after denoising. It showed that the phase difference increases from newborns to 3-4-month-olds babies. This phase difference persists throughout adulthood until finally being disrupted in the old age. The children's PLI is the highest, followed by that of adults. These two groups' PLI are significantly higher than those of infants and the elderly (p < 0.001). Lastly, a hemodynamic model was used to explain the observations and found close associations with cerebral autoregulation and speed of blood flow. These results demonstrate that the phase-related parameters measured by fNIRS can be used to study the brain and assess brain health throughout the lifespan.

Applications and Limitations of Neuro-Monitoring in Paediatric Anaesthesia and Intravenous Anaesthesia: A Narrative Review

Safe management of anaesthesia in children has been one of the top areas of research over the last decade. After the large volume of articles which focused on the putative neurotoxic effect of anaesthetic agents on the developing brain, the attention and research efforts shifted toward prevention and treatment of critical events and the importance of peri-anaesthetic haemodynamic stability to prevent negative neurological outcomes. Safetots.org is an international initiative aiming at raising the attention on the relevance of a high-quality anaesthesia in children undergoing surgical and non-surgical procedures to guarantee a favourable outcome. Children might experience hemodynamic instability for many reasons, and how the range of normality within brain autoregulation is maintained is still unknown. Neuro-monitoring can guide anaesthesia providers in delivering optimal anaesthetic drugs dosages and also correcting underling conditions that can negatively affect the neurological outcome. In particular, it is referred to EEG-based monitoring and monitoring for brain oxygenation.

The LUCA device: a multi-modal platform combining diffuse optics and ultrasound imaging for thyroid cancer screening

We present the LUCA device, a multi-modal platform combining eight-wavelength near infrared time resolved spectroscopy, sixteen-channel diffuse correlation spectroscopy and a clinical ultrasound in a single device. By simultaneously measuring the tissue hemodynamics and performing ultrasound imaging, this platform aims to tackle the low specificity and sensitivity of the current thyroid cancer diagnosis techniques, improving the screening of thyroid nodules. Here, we show a detailed description of the device, components and modules. Furthermore, we show the device tests performed through well established protocols for phantom validation, and the performance assessment for in vivo. The characterization tests demonstrate that LUCA device is capable of performing high quality measurements, with a precision in determining in vivo tissue optical and dynamic properties of better than 3%, and a reproducibility of better than 10% after ultrasound-guided probe repositioning, even with low photon count-rates, making it suitable for a wide variety of clinical applications.

A randomized placebo-control trial of the acute effects of oxygen supplementation on exercise hemodynamics, autonomic modulation, and brain oxygenation in patients with pulmonary hypertension

BACKGROUND

The integrative physiological effects of O₂ treatment on patients with pulmonary hypertension (PH) during exercise, have not been fully investigated. We simultaneously evaluated, for the first time, the effect of oxygen supplementation on hemodynamic responses, autonomic modulation, tissue oxygenation, and exercise performance in patients with pulmonary arterial hypertension (PAH)/Chronic Thromboembolic PH(CTEPH).

MATERIAL-METHODS

In this randomized, cross-over, placebo-controlled trial, stable outpatients with PAH/CTEPH underwent maximal cardiopulmonary exercise testing, followed by two submaximal trials, during which they received supplementary oxygen (O₂) or medical-air. Continuous, non-invasive hemodynamics were monitored via photophlythesmography. Cerebral and quadriceps muscle oxygenation were recorded via near-infrared spectroscopy. Autonomic function was assessed by heart rate variability; root mean square of successive differences (RMSSD) and standard-deviation-Poincare-plot (SD1) were used as indices of parasympathetic output. Baroreceptor sensitivity (BRS) was assessed throughout the protocols.

RESULTS

Nine patients (51.4 ± 9.4 years) were included. With O₂-supplementation patients exercised for longer (p = 0.01), maintained higher cerebral oxygenated hemoglobin (O₂Hb;p = 0.02) levels, exhibited an amelioration in cortical deoxygenation (HHb;p = 0.02), and had higher average cardiac output (CO) during exercise (p < 0.05), compared to medical air; with no differences in muscle oxygenation. With O₂-supplementation patients exhibited higher BRS and sample-entropy throughout the protocol (p < 0.05) vs. medical air, and improved the blunted RMSSD, SD1 responses during exercise (p = 0.024).

CONCLUSION

We show that O₂ administration improves BRS and autonomic function during submaximal exercise in PAH/CTEPH, without significantly affecting muscle oxygenation. The improved autonomic function, along with enhancements in cardiovascular function and cerebral oxygenation, probably contributes to increased exercise tolerance with O₂-supplementation in PH patients.

Role of Optical Neuromonitoring in Neonatal Encephalopathy-Current State and Recent Advances

Neonatal encephalopathy (NE) in term and near-term infants is a significant global health problem; the worldwide burden of disease remains high despite the introduction of therapeutic hypothermia. Assessment of injury severity and effective management in the neonatal intensive care unit (NICU) relies on multiple monitoring modalities from systemic to brain-specific. Current neuromonitoring tools provide information utilized for seizure management, injury stratification, and prognostication, whilst systemic monitoring ensures multi-organ dysfunction is recognized early and supported wherever needed. The neuromonitoring technologies currently used in NE however, have limitations in either their availability during the active treatment window or their reliability to prognosticate and stratify injury confidently in the early period following insult. There is therefore a real need for a neuromonitoring tool that provides cot side, early and continuous monitoring of brain health which can reliably stratify injury severity, monitor response to current and emerging treatments, and prognosticate outcome. The clinical use of near-infrared spectroscopy (NIRS) technology has increased in recent years. Research studies within this population have also increased, alongside the development of both instrumentation and signal processing techniques. Increasing use of commercially available cerebral oximeters in the NICU, and the introduction of advanced optical measurements using broadband NIRS (BNIRS), frequency domain NIRS (FDNIRS), and diffuse correlation spectroscopy (DCS) have widened the scope by allowing the direct monitoring of oxygen metabolism and cerebral blood flow, both key to understanding pathophysiological changes and predicting outcome in NE. This review discusses the role of optical neuromonitoring in NE and why this modality may provide the next significant piece of the puzzle toward understanding the real time state of the injured newborn brain.

Voxelwise and Regional Brain Apparent Diffusion Coefficient Changes on MRI from Birth to 6 Years of Age

Background A framework for understanding rapid diffusion changes from 0 to 6 years of age is important in the detection of neurodevelopmental disorders. Purpose To quantify patterns of normal apparent diffusion coefficient (ADC) development from 0 to 6 years of age. Materials and Methods Previously constructed age-specific ADC atlases from 201 healthy full-term children (108 male; age range, 0-6 years) with MRI scans acquired from 2006 to 2013 at one large academic hospital were analyzed to quantify four patterns: ADC trajectory, rate of ADC change, age of ADC maturation, and hemispheric asymmetries of maturation ages. Patterns were quantified in whole-brain, segmented regional, and voxelwise levels by fitting a two-term exponential model. Hemispheric asymmetries in ADC maturation ages were assessed using t tests with Bonferroni correction. Results The posterior limb of the internal capsule (mean ADC: left hemisphere, 1.18 ×10³μm²/sec; right hemisphere, 1.17 ×10³μm²/sec), anterior limb of the internal capsule (left, 1.11 ×10³μm²/sec; right, 1.09 ×10³μm²/sec), vermis (1.26 ×10³μm²/sec), thalami (left, 1.17 ×10³μm²/sec; right, 1.15 ×10³μm²/sec), and basal ganglia (left, 1.26 ×10³μm²/sec; right, 1.23 ×10³μm²/sec) demonstrate low initial ADC values, indicating an earlier prenatal time course of development. ADC maturation was completed between 1.3 and 2.4 years of age, depending on the region. The vermis and left thalamus matured earliest (1.3 years). The frontolateral gray matter matured latest (right, 2.3 years; left, 2.4 years). ADC maturation occurred earlier in the left hemisphere (P < .001) in several regions, including the frontal (mean ± standard deviation) (left, 2.16 years ± 0.29; right, 2.19 years ± 0.31), temporal (left, 1.93 years ± 0.22; right, 1.99 years ± 0.22), and parietal (left, 1.92 years ± 0.30; right, 2.03 years ± 0.28) white matter. Maturation occurred earlier in the right hemisphere (P < .001) in several regions, including the thalami (left, 1.63 years ± 0.32; right, 1.45 years ± 0.33), basal ganglia (left, 1.79 years ± 0.31; right, 1.70 years ± 0.37), and hippocampi (left, 1.93 years ± 0.34; right, 1.78 years ± 0.33). Conclusion Normative apparent diffusion coefficient developmental patterns on diffusion-weighted MRI scans were quantified in children aged 0 to 6 years. This work provides knowledge about early brain development and may guide the detection of abnormal patterns of maturation. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Rollins in this issue.

Noninvasive optical measurement of microvascular cerebral hemodynamics and autoregulation in the neonatal ECMO patient

BACKGROUND

Extra-corporeal membrane oxygenation (ECMO) is a life-saving intervention for severe respiratory and cardiac diseases. However, 50% of survivors have abnormal neurologic exams. Current ECMO management is guided by systemic metrics, which may poorly predict cerebral perfusion. Continuous optical monitoring of cerebral hemodynamics during ECMO holds potential to detect risk factors of brain injury such as impaired cerebrovascular autoregulation (CA).

METHODS

We conducted daily measurements of microvascular cerebral blood flow (CBF), oxygen saturation, and total hemoglobin concentration using diffuse correlation spectroscopy (DCS) and frequency-domain diffuse optical spectroscopy in nine neonates. We characterize CA utilizing the correlation coefficient (DCSx) between CBF and mean arterial blood pressure (MAP) during ECMO pump flow changes.

RESULTS

Average MAP and pump flow levels were weakly correlated with CBF and were not correlated with cerebral oxygen saturation. CA integrity varied between individuals and with time. Systemic measurements of MAP, pulse pressure, and left cardiac dysfunction were not predictive of impaired CA.

CONCLUSIONS

Our pilot results suggest that systemic measures alone cannot distinguish impaired CA from intact CA during ECMO. Furthermore, optical neuromonitoring could help determine patient-specific ECMO pump flows for optimal CA integrity, thereby reducing risk of secondary brain injury.

IMPACT

Cerebral blood flow and oxygenation are not well predicted by systemic proxies such as ECMO pump flow or blood pressure. Continuous, quantitative, bedside monitoring of cerebral blood flow and oxygenation with optical tools enables new insight into the adequacy of cerebral perfusion during ECMO. A demonstration of hybrid diffuse optical and correlation spectroscopies to continuously measure cerebral blood oxygen saturation and flow in patients on ECMO, enabling assessment of cerebral autoregulation. An observation of poor correlation of cerebral blood flow and oxygenation with systemic mean arterial pressure and ECMO pump flow, suggesting that clinical decision making guided by target values for these surrogates may not be neuroprotective. ~50% of ECMO survivors have long-term neurological deficiencies; continuous monitoring of brain health throughout therapy may reduce these tragically common sequelae through brain-focused adjustment of ECMO parameters.

Frequency-Domain Techniques for Cerebral and Functional Near-Infrared Spectroscopy

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.

The Valsalva maneuver: an indispensable physiological tool to differentiate intra versus extracranial near-infrared signal

Developing near-infrared spectroscopy (NIRS) parameter recovery techniques to more specifically resolve brain physiology from that of the overlying tissue is an important part of improving the clinical utility of the technology. The Valsalva maneuver (VM) involves forced expiration against a closed glottis causing widespread venous congestion within the context of a fall in cardiac output. Due to the specific anatomical confines and metabolic demands of the brain we believe a properly executed VM has the ability to separate haemodynamic activity of brain tissue from that of the overlying scalp as observed by NIRS, and confirmed by functional magnetic resonance imaging (fMRI). Healthy individuals performed a series of standing maximum effort VMs under separate observation by frequency domain near-infrared spectroscopy (FD-NIRS) and fMRI. Nine individuals completed the clinical protocol (6 males, age 21-40). During the VMs, brain and extracranial tissue targeted signal were significantly different (opposite direction of change) in both fMRI and NIRS (p=0.00025 and 0.00115 respectively), with robust cross correlation of parameters between modalities. Four of these individuals performed further VMs after infiltrating 2% xylocaine/1:100,000 epinephrine (vasoconstrictor) into scalp tissue beneath the probes. No significant difference in the cerebrally derived parameters was observed. The maximum effort VM has the ability to separate NIRS observable physiology of the brain from the overlying extracranial tissue. Observations made by this FD cerebral NIRS device are comparable with fMRI in this context.

Comparison of frequency-domain and continuous-wave near-infrared spectroscopy devices during the immediate transition

Background

Non-invasive monitoring of cerebral tissue oxygen saturation (rcSO₂) during transition is of growing interest. Different near-infrared spectroscopy (NIRS) techniques have been developed to measure rcSO₂. We compared rcSO₂ values during the immediate transition in preterm neonates measured with frequency-domain NIRS (FD-NIRS) with those measured with continuous-wave NIRS (CW-NIRS) devices in prospective observational studies.

Methods

We compared rcSO₂ values measured with an FD-NIRS device during the first 15 min after birth in neonates with a gestational age ≥ 30 weeks but < 37 weeks born at the Erasmus MC- Sophia Children’s Hospital, Rotterdam, the Netherlands, with similar values measured with a CW-NIRS device in neonates born at the Medical University of Graz, Austria. Mixed models were used to adjust for repeated rcSO₂ measurements, with fixed effects for time (non-linear), device, respiratory support and the interaction of device and respiratory support with time. Additionally, parameters such as total haemoglobin concentration and oxygenated and deoxygenated haemoglobin concentrations measured by FD-NIRS were analysed.

Results

Thirty-eight FD-NIRS measurements were compared with 58 CW-NIRS measurements. The FD-NIRS rcSO₂ values were consistently higher than the CW-NIRS rcSO₂ values in the first 12 min, irrespective of respiratory support. After adjustment for respiratory support, the time-dependent trend in rcSO₂ differed significantly between techniques (p < 0.01).

Conclusion

As cerebral saturation measured with the FD-NIRS device differed significantly from that measured with the CW-NIRS device, differences in absolute values need to be interpreted with care. Although FD-NIRS devices have technical advantages over CW-NIRS devices, FD-NIRS devices may overestimate true cerebral oxygenation and their benefits might not outweigh the usability of the more clinically viable CW-NIRS devices.

Classification of autism spectrum disorder based on sample entropy of spontaneous functional near infra-red spectroscopy signal

OBJECTIVES

To assess the possibility of distinguishing autism spectrum disorder (ASD) based on the characteristic of spontaneous hemodynamic fluctuations and to explore the location of abnormality in the brain.

METHODS

Using the sample entropy (SampEn) of functional near-infrared spectroscopy (fNIRS) from bilateral inferior frontal gyrus (IFG) and temporal cortex (TC) on 25 children with ASD and 22 typical development (TD) children, the pattern of mind-wandering was assessed. With the SampEn as feature variables, a machine learning classifier was applied to mark ASD and locate the abnormal area in the brain.

RESULTS

The SampEn was generally lower for ASD than TD, indicating the fNIRS series from ASD was unstable, had low fluctuation, and high self-similarity. The classification between ASD and TD could reach 97.6% in accuracy.

CONCLUSIONS

The SampEn of fNIRS could accurately distinguish ASD. The abnormality in terms of the SampEn occurs more frequently in IFG than TC, and more frequently in the left than in the right hemisphere.

SIGNIFICANCE

The results of this study may help to understand the cortical mechanism of ASD and provide a fNIRS-based diagnosis for ASD.

Cerebral hemodynamic responses in preterm-born neonates to visual stimulation: classification according to subgroups and analysis of frontotemporal-occipital functional connectivity

How neurovascular coupling develops in preterm-born neonates has been largely neglected in scientific research. We measured visually evoked (flicker light) hemodynamic responses (HRs) in preterm-born neonates ( n = 25 , gestational age: 31.71 ± 3.37 weeks, postnatal age: 25.48 ± 23.94 days) at the visual cortex (VC) and left frontotemporal lobe (FTL) using functional near-infrared spectroscopy (fNIRS) neuroimaging. We found that the HR characteristics show a large intersubject variability but could be classified into three groups according to the changes of oxyhemoglobin concentration at the VC [(A) increase, (B) decrease, or (C) inconclusive]. In groups A and B, the HRs at the left FTL were correlated with those at the VC, indicating the presence of a frontotemporal-occipital functional connectivity. Neonates in group A had a higher weight at measurement compared to those in group B, and had the lowest baseline total hemoglobin concentration and hematocrit compared to group C. To the best of our knowledge, this is the first fNIRS study showing (1) that the HRs of preterm-born neonates need to be classified into subgroups, (2) that the subgroups differed in terms of weight at measurement, and (3) that HRs can be observed also at the FTL during visual stimulation. These findings add insights into how neurovascular coupling develops in preterm-born neonates.

Near-Infrared Spectroscopy in Pediatric Congenital Heart Disease

Near-infrared spectroscopy (NIRS) is widely used to monitor tissue oxygenation in the pediatric cardiac surgical population. Clinicians who use NIRS must understand the underlying measurement principles in order to interpret and use this monitoring modality appropriately. The aims of this narrative review are to provide a brief overview of NIRS technology, discuss the normative and critical values of cerebral and somatic tissue oxygen saturation and the interpretation of these values, present the clinical studies (and their limitations) of NIRS as a perioperative monitoring modality in the pediatric congenital heart disease population, and introduce the emerging and future applications of NIRS.

High-density functional diffuse optical tomography based on frequency-domain measurements improves image quality and spatial resolution

Measurements of dynamic near-infrared (NIR) light attenuation across the human head together with model-based image reconstruction algorithms allow the recovery of three-dimensional spatial brain activation maps. Previous studies using high-density diffuse optical tomography (HD-DOT) systems have reported improved image quality over sparse arrays. These HD-DOT systems incorporated multidistance overlapping continuous wave measurements that only recover differential intensity attenuation. We investigate the potential improvement in reconstructed image quality due to the additional incorporation of phase shift measurements, which reflect the time-of-flight of the measured NIR light, within the tomographic reconstruction from high-density measurements. To evaluate image reconstruction with and without the additional phase information, we simulated point spread functions across a whole-scalp field of view in 24 subject-specific anatomical models using an experimentally derived noise model. The addition of phase information improves the image quality by reducing localization error by up to 59% and effective resolution by up to 21% as compared to using the intensity attenuation measurements alone. Furthermore, we demonstrate that the phase data enable images to be resolved at deeper brain regions where intensity data fail, which is further supported by utilizing experimental data from a single subject measurement during a retinotopic experiment.

Head model based on the shape of the subject's head for optical brain imaging

Optical imaging methods such as near-infrared spectroscopy and diffuse optical tomography rely on models to solve the inverse problem. Imaging an adult human head also requires a head model. Using a model, which makes describing the structure of the head better, leads to acquiring a more accurate absorption map. Here, by combining the key features of layered slab models and head atlases, we introduce a new two-layered head model that is based on the surface geometry of the subject's head with variable thickness of the superficial layer. Using the Monte Carlo approach, we assess the performance of our model for fitting the optical properties from simulated time-resolved data of the adult head in a null distance source-detector configuration. Using our model, we observed improved results at 70 percent of the locations on the head and an overall 20 percent reduction in relative error compared to layered slab model.

Changes of functional response in sensorimotor cortex of preterm and full-term infants during the first year: An fNIRS study

BACKGROUND

Motor impairments are frequently associated with preterm birth and interfere in acquisition of essential skills to global development. Using Near Infrared Spectroscopy (NIRS), the study of neural correlates of motor development in early stages of life are feasible in an ecological assessment.

AIMS

To evaluate changes in cortical activity in response to a sensorimotor stimulation in preterm and full-term infants at 6 and 12 months of age.

STUDY DESIGN

A longitudinal study was conducted with 22 infants (12 preterm and 10 full-term). Hemodynamic activity during sensorimotor task (8 blocks of 8 s of vibration applied to infant's right hand) was measured by Functional Near Infrared Spectroscopy (fNIRS). The optical probe consisted of 84 channels positioned according to the international 10-20 system coordinates, covering the frontal (38 channels), parietal (16 channels), temporal (22 channels) and occipital (8 channels) lobes of both hemispheres.

RESULTS

Preterm and full-term infants exhibited differences of location of the activation as well on the hemodynamic response in both the evaluated age groups.

CONCLUSIONS

Group differences in activation of sensorimotor cortex observed in this study demonstrate the potential of fNIRS application for preterm evaluation of motor development in children. Overall, the present work contributes to our understanding of cortical activation of cerebral motor skills spanning early ages in preterm-born children.

Neural substrates of early executive function development

In the last decade, advances in neuroimaging technologies have given rise to a large number of research studies that investigate the neural underpinnings of executive function (EF). EF has long been associated with the prefrontal cortex (PFC) and involves both a unified, general element, as well as the distinct, separable elements of working memory, inhibitory control and set shifting. We will highlight the value of utilising advances in neuroimaging techniques to uncover answers to some of the most pressing questions in the field of early EF development. First, this review will explore the development and neural substrates of each element of EF. Second, the structural, anatomical and biochemical changes that occur in the PFC during infancy and throughout childhood will be examined, in order to address the importance of these changes for the development of EF. Third, the importance of connectivity between regions of the PFC and other brain areas in EF development is reviewed. Finally, throughout this review more recent developments in neuroimaging techniques will be addressed, alongside the implications for further elucidating the neural substrates of early EF development in the future.

Exploring early human brain development with structural and physiological neuroimaging

Early brain development, from the embryonic period to infancy, is characterized by rapid structural and functional changes. These changes can be studied using structural and physiological neuroimaging methods. In order to optimally acquire and accurately interpret this data, concepts from adult neuroimaging cannot be directly transferred. Instead, one must have a basic understanding of fetal and neonatal structural and physiological brain development, and the important modulators of this process. Here, we first review the major developmental milestones of transient cerebral structures and structural connectivity (axonal connectivity) followed by a summary of the contributions from ex vivo and in vivo MRI. Next, we discuss the basic biology of neuronal circuitry development (synaptic connectivity, i.e. ensemble of direct chemical and electrical connections between neurons), physiology of neurovascular coupling, baseline metabolic needs of the fetus and the infant, and functional connectivity (defined as statistical dependence of low-frequency spontaneous fluctuations seen with functional magnetic resonance imaging (fMRI)). The complementary roles of magnetic resonance imaging (MRI), electroencephalography (EEG), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS) are discussed. We include a section on modulators of brain development where we focus on the placenta and emerging placental MRI approaches. In each section we discuss key technical limitations of the imaging modalities and some of the limitations arising due to the biology of the system. Although neuroimaging approaches have contributed significantly to our understanding of early brain development, there is much yet to be done and a dire need for technical innovations and scientific discoveries to realize the future potential of early fetal and infant interventions to avert long term disease.

Functional near-infrared spectroscopy as a tool for assessing speech and spoken language processing in pediatric and adult cochlear implant users

Much of what is known about the course of auditory learning in following cochlear implantation is based on behavioral indicators that users are able to perceive sound. Both prelingually deafened children and postlingually deafened adults who receive cochlear implants display highly variable speech and language processing outcomes, although the basis for this is poorly understood. To date, measuring neural activity within the auditory cortex of implant recipients of all ages has been challenging, primarily because the use of traditional neuroimaging techniques is limited by the implant itself. Functional near-infrared spectroscopy (fNIRS) is an imaging technology that works with implant users of all ages because it is non-invasive, compatible with implant devices, and not subject to electrical artifacts. Thus, fNIRS can provide insight into processing factors that contribute to variations in spoken language outcomes in implant users, both children and adults. There are important considerations to be made when using fNIRS, particularly with children, to maximize the signal-to-noise ratio and to best identify and interpret cortical responses. This review considers these issues, recent data, and future directions for using fNIRS as a tool to understand spoken language processing in children and adults who hear through a cochlear implant.

A longitudinal study of infant view-invariant face processing during the first 3-8 months of life

View-invariant face processing emerges early in life. A previous study (Nakato et al., 2009) measured infant hemodynamic responses to faces from the frontal and profile views in the bilateral temporal areas, which have been reported to be involved in face processing using near-infrared spectroscopy. It was reported that 5-month-old infants showed increased oxyhemoglobin (oxy-Hb) responses to frontal faces, but not to profile faces. In contrast, 8-month-old infants displayed increased oxy-Hb responses to profile faces as well as to frontal faces. In this study, we used the experimental method developed in the previous study to investigate the development of view-invariant face processing, every month for 5 months (from the first 3-8 months of life). We longitudinally measured hemodynamic responses to faces from the frontal and profile views in 14 infants. The longitudinal measurements allowed us to investigate individual differences in each participant. We modeled each infant's hemodynamic oxy-Hb responses to frontal and profile faces using linear regression analysis. Processing of profile faces emerged later and underwent larger improvements than that of frontal faces. We also found an anticorrelation between the speed of improvement in face processing and the hemodynamic response to faces at the age of 3- months. Group analysis of the averaged hemodynamic data from the 14 infants using linear regression revealed that the processing of profile faces emerged between 5 and 6 months of age. Infant view-invariant face processing developed first for frontal faces. This was followed by the emergence of processing of profile faces.

Prolonged monitoring of cerebral blood flow and autoregulation with diffuse correlation spectroscopy in neurocritical care patients

Monitoring of cerebral blood flow (CBF) and autoregulation are essential components of neurocritical care, but continuous noninvasive methods for CBF monitoring are lacking. Diffuse correlation spectroscopy (DCS) is a noninvasive diffuse optical modality that measures a CBF index ( CBF i ) in the cortex microvasculature by monitoring the rapid fluctuations of near-infrared light diffusing through moving red blood cells. We tested the feasibility of monitoring CBF i with DCS in at-risk patients in the Neurosciences Intensive Care Unit. DCS data were acquired continuously for up to 20 h in six patients with aneurysmal subarachnoid hemorrhage, as permitted by clinical care. Mean arterial blood pressure was recorded synchronously, allowing us to derive autoregulation curves and to compute an autoregulation index. The autoregulation curves suggest disrupted cerebral autoregulation in most patients, with the severity of disruption and the limits of preserved autoregulation varying between subjects. Our findings suggest the potential of the DCS modality for noninvasive, long-term monitoring of cerebral perfusion, and autoregulation.

Symbolic time series analysis of fNIRS signals in brain development assessment

OBJECTIVE

Assessing an infant's brain development remains a challenge for neuroscientists and pediatricians despite great technological advances. As a non-invasive neuroimaging tool, functional near-infrared spectroscopy (fNIRS) has great advantages in monitoring an infant's brain activity. To explore the dynamic features of hemodynamic changes in infants, in-pattern exponent (IPE), anti-pattern exponent (APE), as well as permutation cross-mutual information (PCMI) based on symbolic dynamics are proposed to measure the phase differences and coupling strength in oxyhemoglobin (HbO) and deoxyhemoglobin (Hb) signals from fNIRS.

APPROACH

First, simulated sinusoidal oscillation signals and four coupled nonlinear systems were employed for performance assessments. Hilbert transform based measurements of hemoglobin phase oxygenation and deoxygenation (hPod) and phase-locking index of hPod (hPodL) were calculated for comparison. Then, the IPE, APE and PCMI indices from resting state fNIRS data of preterm, term infants and adults were calculated to estimate the phase difference and coupling of HbO and Hb. All indices' performance was assessed by the degree of monotonicity (DoM). The box plots and coefficients of variation (CV) were employed to assess the measurements and robustness in the results.

MAIN RESULTS

In the simulation analysis, IPE and APE can distinguish the phase difference of two sinusoidal oscillation signals. Both hPodL and PCMI can track the strength of two coupled nonlinear systems. Compared to hPodL, the PCMI had higher DoM indices in measuring the coupling of two nonlinear systems. In the fNIRS data analysis, similar to hPod, the IPE and APE can distinguish preterm, term infants, and adults in 0.01-0.05 Hz, 0.05-0.1 Hz, and 0.01-0.1 Hz frequency bands, respectively. PCMI more effectively distinguished the term and preterm infants than hPodL in the 0.05-0.1 Hz frequency band. As symbolic time series measures, the IPE and APE were able to detect the brain developmental changes in subjects of different ages. PCMI can assess the resting-state HbO and Hb coupling changes across different developmental ages, which may reflect the metabolic and neurovascular development.

SIGNIFICANCE

The symbolic-based methodologies are promising measures for fNIRS in estimating the brain development, especially in assessing newborns' brain developmental status.

The effects of multi-stage exercise with and without concurrent cognitive performance on cardiorespiratory and cerebral haemodynamic responses

INTRODUCTION

Studies of cerebral haemodynamics have shown changes with increased exercise intensity, but the patterns have been highly variable and reliable associations with cognitive performance have not been identified. The aim of this study was to examine whether exercise-induced changes in oxygenated haemoglobin (O₂Hb) led to changes in concomitant cognitive performance.

METHODS

This study examined cardiorespiratory and cerebral haemodynamics during multi-stage exercise from rest to exhaustion, with (Ex + C) and without (Ex) concurrent cognitive performance (Go/No-go task).

RESULTS

The presence of the cognitive task affected both cardiorespiratory and cerebral haemodynamics. The patterns in the cerebral haemodynamics during Ex and Ex + C diverged above the respiratory compensation threshold (RCT), but differences were significant only at 100% [Formula: see text], displaying increased deoxygenated haemoglobin (HHb), decreased difference between oxygenated and deoxygenated haemoglobin (HbDiff), and decreased cerebral oxygenation (COx) during Ex + C. More complex haemodynamic trends against intensity during Ex + C suggested that the presence of a cognitive task increases cerebral metabolic demand at high exercise intensities. The levels of O₂Hb, HHb, HbDiff and total haemoglobin increased most steeply at intensities around the RCT during both Ex and Ex + C, but these changes were not accompanied by improved cognitive performance.

CONCLUSION

The primary hypothesis, that cognitive performance would match changes in O₂Hb, was not supported. Small variations in reaction time and response accuracy across exercise intensities were not significant, suggesting that cognitive performance is unaffected by intense short-duration exercise. Our results add further evidence that exercise-induced changes in cerebral haemodynamics do not affect cognitive performance.

Multiwavelength time-resolved near-infrared spectroscopy of the adult head: assessment of intracerebral and extracerebral absorption changes

An optical technique based on diffuse reflectance measurement combined with indocyanine green (ICG) bolus tracking is extensively tested as a method for the clinical assessment of brain perfusion at the bedside. We report on multiwavelength time-resolved diffuse reflectance spectroscopy measurements carried out on the head of a healthy adult during the intravenous administration of a bolus of ICG. Intracerebral and extracerebral changes in absorption were estimated from an analysis of changes in statistical moments (total number of photons, mean time of flight and variance) of the distributions of times of flight (DTOF) of photons recorded simultaneously at 16 wavelengths from the range of 650-850 nm using sensitivity factors estimated by diffusion approximation based on a layered model of the studied medium. We validated the proposed method in a series of phantom experiments and in-vivo measurements. The results obtained show that changes in the concentration of the ICG can be assessed as a function of time of the experiment and depth in the tissue. Thus, the separation of changes in ICG concentration appearing in intra- and extracerebral tissues can be estimated from optical data acquired at a single source-detector pair of fibers/fiber bundles positioned on the surface of the head.

Preoperative cerebral hemodynamics from birth to surgery in neonates with critical congenital heart disease

BACKGROUND

Hypoxic-ischemic white matter brain injury commonly occurs in neonates with critical congenital heart disease. Recent work has shown that longer time to surgery is associated with increased risk for this injury. In this study we investigated changes in perinatal cerebral hemodynamics during the transition from fetal to neonatal circulation to ascertain mechanisms that might underlie this risk.

METHODS

Neonates with either transposition of the great arteries (TGA) or hypoplastic left heart syndrome (HLHS) were recruited for preoperative noninvasive optical monitoring of cerebral oxygen saturation, cerebral oxygen extraction fraction, and cerebral blood flow using diffuse optical spectroscopy and diffuse correlation spectroscopy, 2 noninvasive optical techniques. Measurements were acquired daily from day of consent until the morning of surgery. Temporal trends in these measured parameters during the preoperative period were assessed with a mixed effects model.

RESULTS

Forty-eight neonates with TGA or HLHS were studied. Cerebral oxygen saturation was significantly and negatively correlated with time, and oxygen extraction fraction was significantly and positively correlated with time. Cerebral blood flow did not significantly change with time during the preoperative period.

CONCLUSIONS

In neonates with TGA or HLHS, increasing cerebral oxygen extraction combined with an abnormal cerebral blood flow response during the time between birth and heart surgery leads to a progressive decrease in cerebral tissue oxygenation The results support and help explain the physiological basis for recent studies that show longer time to surgery increases the risk of acquiring white matter injury.

Multi-task prediction of infant cognitive scores from longitudinal incomplete neuroimaging data

Early postnatal brain undergoes a stunning period of development. Over the past few years, research on dynamic infant brain development has received increased attention, exhibiting how important the early stages of a child's life are in terms of brain development. To precisely chart the early brain developmental trajectories, longitudinal studies with data acquired over a long-enough period of infants' early life is essential. However, in practice, missing data from different time point(s) during the data gathering procedure is often inevitable. This leads to incomplete set of longitudinal data, which poses a major challenge for such studies. In this paper, prediction of multiple future cognitive scores with incomplete longitudinal imaging data is modeled into a multi-task machine learning framework. To efficiently learn this model, we account for selection of informative features (i.e., neuroimaging morphometric measurements for different time points), while preserving the structural information and the interrelation between these multiple cognitive scores. Several experiments are conducted on a carefully acquired in-house dataset, and the results affirm that we can predict the cognitive scores measured at the age of four years old, using the imaging data of earlier time points, as early as 24 months of age, with a reasonable performance (i.e., root mean square error of 0.18).

Development and characterization of a multidistance and multiwavelength diffuse correlation spectroscopy system

This paper presents a multidistance and multiwavelength diffuse correlation spectroscopy (DCS) approach and its implementation to simultaneously measure the optical proprieties of deep tissue as well as the blood flow. The system consists of three long coherence length lasers at different wavelengths in the near-infrared, eight single-photon detectors, and a correlator board. With this approach, we collect both light intensity and DCS data at multiple distances and multiple wavelengths, which provide unique information to fit for all the parameters of interest: scattering, blood flow, and hemoglobin concentration. We present the characterization of the system and its validation with phantom measurements.

Spatial variation in the hemoglobin phase of oxygenation and deoxygenation in the developing cortex of infants

Spontaneous low-frequency oscillatory changes in oxygenated hemoglobin (oxy-Hb) and deoxygenated hemoglobin (deoxy-Hb) are observed using functional near-infrared spectroscopy (fNIRS). A previous study showed that the time-averaged phase difference between oxy-Hb and deoxy-Hb changes, referred to as hemoglobin phase of oxygenation and deoxygenation (hPod), is sensitive to the development of the cortex. We examined phase-locking index of hPod, referred to as [Formula: see text], in addition to hPod, in neonates and 3- and 6-month-old infants using the 94-channel fNIRS data, which covered large lateral regions of the cortex. The results showed that (1) developmental changes in hPod exhibited spatial dependency; (2) [Formula: see text] increased between the neonate group and 3-month-old infant group over the posterior, but not anterior, regions of the cortex; and (3) the cortical regions of each age group were clustered in several domains with specific characteristics of hPod and [Formula: see text]. This study indicates that the neonatal cortex is composed of regions with specific characteristics of hPod and [Formula: see text], and drastic changes occur between the neonatal period and 3 months of age. This study suggests that hPod and [Formula: see text] are sensitive to the cortical region-specific development of the circulatory, blood flow, metabolic, and neurovascular functions in young infants.

Shedding light on the neonatal brain: probing cerebral hemodynamics by diffuse optical spectroscopic methods

Investigating the cerebral physiology of healthy term newborns' brains is important for better understanding perinatal brain injuries, of which the most common etiologies are hypoxia and ischemia. Hence, cerebral blood flow and cerebral oxygenation are important biomarkers of brain health. In this study, we employed a hybrid diffuse optical system consisting of diffuse correlation spectroscopy (DCS) and frequency-domain near infrared spectroscopy (FDNIRS) to measure hemoglobin concentration, oxygen saturation, and indices of cerebral blood flow and metabolism. We measured 30 term infants to assess the optical and physiological characteristics of the healthy neonatal brain in the frontal, temporal, and parietal lobes. We observed higher metabolism in the right hemisphere compared to the left and a positive correlation between gestational age and the level of cerebral hemoglobin concentration, blood volume, and oxygen saturation. Moreover, we observed higher cerebral blood flow and lower oxygen saturation in females compared to males. The delayed maturation in males and the sexual dimorphism in cerebral hemodynamics may explain why males are more vulnerable to perinatal brain injuries than females.

Shedding light on the neonatal brain: probing cerebral hemodynamics by diffuse optical spectroscopic methods

Investigating the cerebral physiology of healthy term newborns' brains is important for better understanding perinatal brain injuries, of which the most common etiologies are hypoxia and ischemia. Hence, cerebral blood flow and cerebral oxygenation are important biomarkers of brain health. In this study, we employed a hybrid diffuse optical system consisting of diffuse correlation spectroscopy (DCS) and frequency-domain near infrared spectroscopy (FDNIRS) to measure hemoglobin concentration, oxygen saturation, and indices of cerebral blood flow and metabolism. We measured 30 term infants to assess the optical and physiological characteristics of the healthy neonatal brain in the frontal, temporal, and parietal lobes. We observed higher metabolism in the right hemisphere compared to the left and a positive correlation between gestational age and the level of cerebral hemoglobin concentration, blood volume, and oxygen saturation. Moreover, we observed higher cerebral blood flow and lower oxygen saturation in females compared to males. The delayed maturation in males and the sexual dimorphism in cerebral hemodynamics may explain why males are more vulnerable to perinatal brain injuries than females.

A Pilot Randomized Controlled Trial of a New Supplementary Food Designed to Enhance Cognitive Performance during Prevention and Treatment of Malnutrition in Childhood

BACKGROUND

Cognitive impairment associated with childhood malnutrition and stunting is generally considered irreversible.

OBJECTIVE

The aim was to test a new nutritional supplement for the prevention and treatment of moderate-acute malnutrition (MAM) focused on enhancing cognitive performance.

METHODS

An 11-wk, village-randomized, controlled pilot trial was conducted in 78 children aged 1-3 or 5-7 y living in villages in Guinea-Bissau. The supplement contained 291 kcal/d for young children and 350 kcal/d for older children and included 5 nutrients and 2 flavan-3-ol-rich ingredients not present in current food-based recommendations for MAM. Local bakers prepared the supplement from a combination of locally sourced items and an imported mix of ingredients, and it was administered by community health workers 5 d/wk. The primary outcome was executive function abilities at 11 wk. Secondary outcomes included additional cognitive measures and changes in z scores for weight (weight-for-age) and height (height-for-age) and hemoglobin concentrations at 11 wk. An index of cerebral blood flow (CBF) was also measured at 11 wk to explore the use of this measurement as a biological index of cognitive impairment.

RESULTS

There were no significant differences in any outcome between groups at baseline. There was a beneficial effect of random assignment to the supplement group on working memory at 11 wk in children aged 1-3 y (P < 0.05). This difference contrasted with no effect in older children and was not associated with faster growth rate. In addition, CBF correlated with task-switching performance (P < 0.05).

CONCLUSIONS

These preliminary data suggest that cognitive impairment can be monitored with measurement of CBF. In addition, the findings provide preliminary data that suggest that it may be possible to improve poor cognitive performance in young children through changes in the nutritional formulation of supplementary foods used to prevent and treat MAM. Powered studies of the new supplement formulation are needed. This trial was registered at clinicaltrials.gov as NCT03017209.