VASOREACTIVITY OF CEREBRAL HEMODYNAMICS-NEONATES WITH CONGENITAL HEART DEFECTS

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 新生儿心脏手术幸存者的神经发育受损结局已观察到 先天性心脏缺陷。先前有证据表明，术前脑部检查的重要性 幸福感取决于观察到的结果。此外，众所周知，手术参数 其中包括心脏旁路、深冷和停搏需要通过床边实时优化 监控。一个很大程度上无法获得的关键参数是脑血流量(CBF)。我们有 近几年发展起来的漫相关光谱技术，用于无创、连续的 相对脑血流量的测量。在这项工作中，我们报告了其临床应用的第一个结果 与漫反射光谱(DOS)相结合的新生儿血液测量 氧合作用和脑氧代谢。在这项两组队列研究中，患有严重疾病的新生儿 计划进行心脏手术的先天性心脏缺陷在手术前被测量以评估 大脑二氧化碳的反应性和自我调节。第一个队列(n=44)是在 磁共振磁体和分布式控制系统测量中延长的高碳酸血症与 动脉自旋标记MRI测量脑血流量显示两种方法具有良好的一致性。一个 没有观察到二氧化碳反应性的损害，因为报道的二氧化碳反应性值范围很大 在文献和样本量上。第二个队列现在正在招募(n=6)更多 延长监测范围，包括术前准备期和统计比较 结果与术后结果测量结果一致。最终，我们将监测大脑的健康状况 在心脏手术期间和之后立即利用光学技术的力量 床边监护。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Impaired neurodevelopmental outcome has been observed for survivors of neonatal heart surgery for congenital heart defects. There is prior evidence indicating the importance of preoperative cerebral well-being on the observed outcome. Furthermore, it is well known that the surgical parameters which include cardiac by-pass, deep-cooling and arrest need to be optimized via real-time, bed-side monitoring. A crucial parameter that is largely inaccessible is the cerebral blood flow (CBF). We have recently developed diffuse correlation spectroscopy (DCS) for non-invasive, continuous measurement of relative CBF. In this work, we report our first results from its clinical application to neonates where it was combined with diffuse optical spectroscopy (DOS) for measurement of blood oxygenation and cerebral oxygen metabolism. In this two-cohort study, Neonates with severe congenital heart defects scheduled for cardiac surgery were measured preoperatively to assess cerebral CO2 reactivity and autoregulation. The first cohort (n=44) was measured during an extended period of hypercapnia in the MRI magnet and DCS measurement was validated against arterial spin-labeling MRI measure of CBF showing good agreement between two methods. An impairment of CO2 reactivity was not observed due to large range of CO2 reactivity values reported in the literature and the sample size. The second cohort is now being recruited (n=6) for a more extended monitoring including the preoperative preparation period and statistically comparing the findings with the post-operative outcome measures. Ultimately, we will monitor cerebral well-being during and immediately after cardiac surgery utilizing the power of the optical techniques for bed-side monitoring.