Simulation of Preterm Neonatal Brain Metabolism During Functional Neuronal Activation Using a Computational Model

We present a computational model of metabolism in the preterm neonatal brain. The model has the capacity to mimic haemodynamic and metabolic changes during functional activation and simulate functional near-infrared spectroscopy (fNIRS) data. As an initial test of the model's efficacy, we simulate data obtained from published studies investigating functional activity in preterm neonates. In addition we simulated recently collected data from preterm neonates during visual activation. The model is well able to predict the haemodynamic and metabolic changes from these observations. In particular, we found that changes in cerebral blood flow and blood pressure may account for the observed variability of the magnitude and sign of stimulus-evoked haemodynamic changes reported in preterm infants

Development of a novel diffuse correlation spectroscopy platform for monitoring cerebral blood flow and oxygen metabolism: from novel concepts and devices to preclinical live animal studies

New optical technologies were developed to continuously measure cerebral blood flow (CBF) and oxygen metabolism (CMRO2) non-invasively through the skull. Methods and devices were created to improve the performance of near-infrared spectroscopy (NIRS) and diffuse correlation spectroscopy (DCS) for use in experimental animals and humans. These were employed to investigate cerebral metabolism and cerebrovascular reactivity under different states of anesthesia and during models of pathological states. Burst suppression is a brain state arising naturally in pathological conditions or under deep general anesthesia, but its mechanism and consequences are not well understood. Electroencephalography (EEG) and cortical hemodynamics were simultaneously measured in rats to evaluate the coupling between cerebral oxygen metabolism and neuronal activity in the burst suppressed state. EEG bursts were used to deconvolve NIRS and DCS signals into the hemodynamic and metabolic response function for an individual burst. This response was found to be similar to the stereotypical functional hyperemia evoked by normal brain activation. Thus, spontaneous burst activity does not cause metabolic or hemodynamic dysfunction in the cortex. Furthermore, cortical metabolic activity was not associated with the initiation or termination of a burst. A novel technique, time-domain DCS (TD-DCS), was introduced to significantly increase the sensitivity of transcranial CBF measurements to the brain. A new time-correlated single photon counting (TCSPC) instrument with a custom high coherence pulsed laser source was engineered for the first-ever simultaneous measurement of photon time of flight and DCS autocorrelation decays. In this new approach, photon time tags are exploited to determine path-length-dependent autocorrelation functions. By correlating photons according to time of flight, CBF is distinguished from superficial blood flow. Experiments in phantoms and animals demonstrate TD-DCS has significantly greater sensitivity to the brain than existing transcranial techniques. Intracranial pressure (ICP) modulates both steady-state and pulsatile CBF, making CBF a potential marker for ICP. In particular, the critical closing pressure (CrCP) has been proposed as a surrogate measure of ICP. A new DCS device was developed to measure pulsatile CBF non-invasively. A novel method for estimating CrCP and ICP from DCS measurement of pulsatile microvascular blood flow in the cerebral cortex was demonstrated in rats.2018-03-08T00:00:00

Functional Electrical Impedance Tomography of adult and neonatal brain function.

Electrical Impedance Tomography (EIT) is a fast, portable imaging technique that produces tomographic images of the internal impedance of an object from surface electrode measurements. This thesis reports the first use of EIT to image evoked brain activity in adults and neonates and determines whether accurate EIT images could be obtained from the adult and neonatal brain. In addition, a realistic head-tank phantom was developed to test the performance of EIT with known impedance changes placed within a real human skull. Two EIT systems were used. Images were obtained using 31 or 21 Ag/AgCl EEG scalp electrodes in adults and neonates, respectively, with either 256 or 187 individual impedance measurements from different electrode combinations: 2 applied a safe, alternating current and 2 measured the resultant scalp voltage. Imaging was performed using a block design with 6-15 stimulation periods of between 10-75s during either: 1) Visual, 2) Somatosensory or 3) Motor stimuli. Impedance changes were detected in 38/39 adults and 9/9 neonates within 0.6-5.8s after stimulus onset, and returned to baseline 7.6-36s after stimulus cessation. Reconstructed images were noisy: -20-70% images showed correct localisation to the expected area of cortex stimulated by the visual, motor or somatosensory paradigms. As EIT images from the head-tank localised changes within 10% of the impedance perturbation, this indicated that poor localisation in humans was not due to the head-shape or the skull, but may be related to unknown physiological factors. An improved EIT reconstruction algorithm, using a computerised finite-element model of the head, showed improved localisation for the adult images. This is the first demonstration that EIT can detect and image impedance changes in the head, probably due to increased regional cerebral blood volume in the activated cortex. Improvements may enable more accurate neuroimaging of the adult and neonatal brain for use in clinical practice

Characterisation of the Haemodynamic Response Function (HRF) in the neonatal brain using functional MRI

Background: Preterm birth is associated with a marked increase in the risk of later neurodevelopmental impairment. With the incidence rising, novel tools are needed to provide an improved understanding of the underlying pathology and better prognostic information. Functional Magnetic Resonance Imaging (fMRI) with Blood Oxygen Level Dependent (BOLD) contrast has the potential to add greatly to the knowledge gained through traditional MRI techniques. However, it has been rarely used with neonatal subjects due to difficulties in application and inconsistent results. Central to this is uncertainity regarding the effects of early brain development on the Haemodynamic Response Function (HRF), knowledge of which is fundamental to fMRI methodology and analysis. Hypotheses: (1) Well localised and positive BOLD functional responses can be identified in the neonatal brain. (2) The morphology of the neonatal HRF differs significantly during early human development. (3) The application of an age-appropriate HRF will improve the identification of functional responses in neonatal fMRI studies. Methods: To test these hypotheses, a systematic fMRI study of neonatal subjects was carried out using a custom made somatosensory stimulus, and an adapted study design and analysis pipeline. The neonatal HRF was then characterised using an event related study design. The potential future application of the findings was then tested in a series of small experiments. Results: Well localised and positive BOLD functional responses were identified in neonatal subjects, with a maturational tendency towards an increasingly complex pattern of activation. A positive amplitude HRF was identified in neonatal subjects, with a maturational trend of a decreasing time-to-peak and increasing positive peak amplitude. Application of the empirical HRF significantly improved the precision of analysis in further fMRI studies. Conclusions: fMRI can be used to study functional activity in the neonatal brain, and may provide vital new information about both development and pathology

Developing High-Density Diffuse Optical Tomography for Neuroimaging

Clinicians who care for brain-injured patients and premature infants desire a bedside monitor of brain function. A decade ago, there was hope that optical imaging would be able to fill this role, as it combined fMRI\u27s ability to construct cortical maps with EEG\u27s portable, cap-based systems. However, early optical systems had poor imaging performance, and the momentum for the technique slowed. In our lab, we develop diffuse optical tomography: DOT), which is a more advanced method of performing optical imaging. My research has been to pioneer the in vivo use of DOT for advanced neuroimaging by: 1) quantifying the advantages of DOT through both in silico simulation and in vivo performance metrics,: 2) restoring confidence in the technique with the first retinotopic mapping of the visual cortex: a benchmark for fMRI and PET), and: 3) creating concepts and methods for the clinical translation of DOT. Hospitalized patients are unable to perform complicated neurological tasks, which has motivated us to develop the first DOT methods for resting-state brain mapping with functional connectivity. Finally, in collaboration with neonatologists, I have extended these methods with proof-of-principle imaging of brain-injured premature infants. This work establishes DOT\u27s improvements in imaging performance and readies it for multiple clinical and research roles

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

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

From Acoustic Segmentation to Language Processing: Evidence from Optical Imaging

During language acquisition in infancy and when learning a foreign language, the segmentation of the auditory stream into words and phrases is a complex process. Intuitively, learners use “anchors” to segment the acoustic speech stream into meaningful units like words and phrases. Regularities on a segmental (e.g., phonological) or suprasegmental (e.g., prosodic) level can provide such anchors. Regarding the neuronal processing of these two kinds of linguistic cues a left-hemispheric dominance for segmental and a right-hemispheric bias for suprasegmental information has been reported in adults. Though lateralization is common in a number of higher cognitive functions, its prominence in language may also be a key to understanding the rapid emergence of the language network in infants and the ease at which we master our language in adulthood. One question here is whether the hemispheric lateralization is driven by linguistic input per se or whether non-linguistic, especially acoustic factors, “guide” the lateralization process. Methodologically, functional magnetic resonance imaging provides unsurpassed anatomical detail for such an enquiry. However, instrumental noise, experimental constraints and interference with EEG assessment limit its applicability, pointedly in infants and also when investigating the link between auditory and linguistic processing. Optical methods have the potential to fill this gap. Here we review a number of recent studies using optical imaging to investigate hemispheric differences during segmentation and basic auditory feature analysis in language development