Abstract TP400: Evoked Functional Cerebral Hemodynamic and Metabolic Responses in Premature Infants with and without Germinal Matrix Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pei-Yi Lin ◽  
Fang-Yu Cheng ◽  
Katherine Hagan ◽  
Yvonne Sheldon ◽  
Ellen P. Grant ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Continuous Wave ◽  
Oxygen Metabolism ◽  
Correlation Spectroscopy ◽  
Germinal Matrix ◽  
Germinal Matrix Hemorrhage

We have created an innovative new method which uses frequency domain near-infrared spectroscopy (FDNIRS) in combination with diffuse correlation spectroscopy (DCS) to quantitatively measure cerebral blood flow (CBF) and oxygen metabolism (CMRO 2 ) right at the infant’s bedside. We have previously found CBF and CMRO 2 are more sensitive indicators of cerebral pathophysiology than hemoglobin saturation (SO 2 ). Using FDNIRS-DCS, we had found extremely premature infants with germinal matrix hemorrhage (GMH) have lower cerebral blood flow (CBF) and oxygen metabolism (CMRO 2 ) than gestational age-matched controls. For this study, we investigate whether GMH, along with age and hematocrit levels, affect evoked hemodynamic responses. The study protocol was reviewed and approved by the Institutional Review Board for Partners Healthcare. We enrolled eleven premature infants in the neonatal intensive care unit at Brigham and Women’s Hospital. Three of them had Grade I GMH diagnosed by head ultrasound on the first three days of life. We integrated continuous wave NIRS (CWNIRS) with DCS to measure dynamic changes of cerebral hemoglobin concentrations (HbO) and CBF in response to somatosensory stimuli. For each measurement, we measured differential path length factors and baseline cerebral hemoglobin concentrations with FDNIRS to quantify relative hemodynamic and metabolic changes (rHbO, rCBF and rCMRO 2 ) in response to tactile stimulation. We observed a faster response time to reach peak value in preterm infants with increasing postmenstrual age (PMA), demonstrating the response matures with age to become more adult-like (r=-0.513, p=0.007). In addition, infants measured at older PMA tend to have responses with a larger undershoot in HbO. However, the HbO undershoot did not translate into an undershoot in CMRO 2 . The HbO undershoot may therefore be a consequence of low hematocrit during the first two months of life which results in insufficient oxygen supply and leads to abnormally large oxygen extraction from the blood. We found the activation pattern of Grade I GMH infants did not differ from premature infants without hemorrhage. The study is ongoing and shows our method is suitable to measure cerebral maturation in neonates with hemorrhage.

scholarly journals Near-infrared spectroscopy measurements of cerebral blood flow and oxygen consumption following hypoxia-ischemia in newborn piglets

2006 ◽  
Vol 100 (3) ◽  
pp. 850-857 ◽  
Author(s):  
Kenneth M. Tichauer ◽  
Derek W. Brown ◽  
Jennifer Hadway ◽  
Ting-Yim Lee ◽  
Keith St. Lawrence
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Hemoglobin Concentration ◽  
Oxygen Extraction Fraction ◽  
Newborn Piglets ◽  
Hypoxia Ischemia

Impaired oxidative metabolism following hypoxia-ischemia (HI) is believed to be an early indicator of delayed brain injury. The cerebral metabolic rate of oxygen (CMRO2) can be measured by combining near-infrared spectroscopy (NIRS) measurements of cerebral blood flow (CBF) and cerebral deoxy-hemoglobin concentration. The ability of NIRS to measure changes in CMRO2 following HI was investigated in newborn piglets. Nine piglets were subjected to 30 min of HI by occluding both carotid arteries and reducing the fraction of inspired oxygen to 8%. An additional nine piglets served as sham-operated controls. Measurements of CBF, oxygen extraction fraction (OEF), and CMRO2 were obtained at baseline and at 6 h after the HI insult. Of the three parameters, only CMRO2 showed a persistent and significant change after HI. Five minutes after reoxygenation, there was a 28 ± 12% (mean ± SE) decrease in CMRO2, a 72 ± 50% increase in CBF, and a 56 ± 19% decrease in OEF compared with baseline ( P < 0.05). By 30 min postinsult and for the remainder of the study, there were no significant differences in CBF and OEF between control and insult groups, whereas CMRO2 remained depressed throughout the 6-h postinsult period. This study demonstrates that NIRS can measure decreases in CMRO2 caused by HI. The results highlight the potential for NIRS to be used in the neonatal intensive care unit to detect delayed brain damage.

Cerebral Blood Flow of the Neonatal Brain after Hypoxic-Ischemic Injury

2021 ◽  
Author(s):  
Luis Octavio Tierradentro-García ◽  
Sandra Saade-Lemus ◽  
Colbey Freeman ◽  
Matthew Kirschen ◽  
Hao Huang ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Near Infrared ◽  
Imaging Modality ◽  
Brain Perfusion ◽  
Correlation Spectroscopy ◽  
Therapeutic Interventions ◽  
Routine Practice ◽  
Diffuse Correlation Spectroscopy ◽  
Positron Emission

Objective Hypoxic-ischemic encephalopathy (HIE) in infants can have long-term adverse neurodevelopmental effects and markedly reduce quality of life. Both the initial hypoperfusion and the subsequent rapid reperfusion can cause deleterious effects in brain tissue. Cerebral blood flow (CBF) assessment in newborns with HIE can help detect abnormalities in brain perfusion to guide therapy and prognosticate patient outcomes. Study Design The review will provide an overview of the pathophysiological implications of CBF derangements in neonatal HIE, current and emerging techniques for CBF quantification, and the potential to utilize CBF as a physiologic target in managing neonates with acute HIE. Conclusion The alterations of CBF in infants during hypoxia-ischemia have been studied by using different neuroimaging techniques, including nitrous oxide and xenon clearance, transcranial Doppler ultrasonography, contrast-enhanced ultrasound, arterial spin labeling MRI, 18F-FDG positron emission tomography, near-infrared spectroscopy (NIRS), functional NIRS, and diffuse correlation spectroscopy. Consensus is lacking regarding the clinical significance of CBF estimations detected by these different modalities. Heterogeneity in the imaging modality used, regional versus global estimations of CBF, time for the scan, and variables impacting brain perfusion and cohort clinical characteristics should be considered when translating the findings described in the literature to routine practice and implementation of therapeutic interventions. Key Points

scholarly journals Portable Near-Infrared Technologies and Devices for Noninvasive Assessment of Tissue Hemodynamics

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Lin Hou ◽  
Yinqiu Liu ◽  
Lixia Qian ◽  
Yucong Zheng ◽  
Jinnan Gao ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Measurement ◽  
Near Infrared ◽  
Tissue Oxygenation ◽  
Oxygen Metabolism ◽  
Correlation Spectroscopy ◽  
Tissue Blood Flow ◽  
Diffuse Optical Spectroscopy ◽  
Diffuse Correlation Spectroscopy ◽  
Custom Made

Tissue hemodynamics, including the blood flow, oxygenation, and oxygen metabolism, are closely associated with many diseases. As one of the portable optical technologies to explore human physiology and assist in healthcare, near-infrared diffuse optical spectroscopy (NIRS) for tissue oxygenation measurement has been developed for four decades. In recent years, a dynamic NIRS technology, namely, diffuse correlation spectroscopy (DCS), has been emerging as a portable tool for tissue blood flow measurement. In this article, we briefly describe the basic principle and algorithms for static NIRS and dynamic NIRS (i.e., DCS). Then, we elaborate on the NIRS instrumentation, either commercially available or custom-made, as well as their applications to physiological studies and clinic. The extension of NIRS/DCS from spectroscopy to imaging was depicted, followed by introductions of advanced algorithms that were recently proposed. The future prospective of the NIRS/DCS and their feasibilities for routine utilization in hospital is finally discussed.

scholarly journals Near-Infrared Spectroscopy Assessment of Cerebral Oxygen Metabolism in the Developing Premature Brain

2011 ◽  
Vol 32 (3) ◽  
pp. 481-488 ◽  
Author(s):  
Nadège Roche-Labarbe ◽  
Angela Fenoglio ◽  
Alpna Aggarwal ◽  
Mathieu Dehaes ◽  
Stefan A Carp ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Correlation Spectroscopy ◽  
Chronological Age ◽  
Flow Index ◽  
P Value ◽  
Blood Flow Index

Little is known about cerebral blood flow, cerebral blood volume (CBV), oxygenation, and oxygen consumption in the premature newborn brain. We combined quantitative frequency-domain near-infrared spectroscopy measures of cerebral hemoglobin oxygenation (SO2) and CBV with diffusion correlation spectroscopy measures of cerebral blood flow index (BFix) to determine the relationship between these measures, gestational age at birth (GA), and chronological age. We followed 56 neonates of various GA once a week during their hospital stay. We provide absolute values of SO2 and CBV, relative values of BFix, and relative cerebral metabolic rate of oxygen (rCMRO2) as a function of postmenstrual age (PMA) and chronological age for four GA groups. SO2 correlates with chronological age ( r=−0.54, P value 0.001) but not with PMA ( r=−0.07), whereas BFix and rCMRO2 correlate better with PMA ( r=0.37 and 0.43, respectively, P value 0.001). Relative CMRO2 during the first month of life is lower when GA is lower. Blood flow index and rCMRO2 are more accurate biomarkers of the brain development than SO2 in the premature newborns.

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