Augmented Physiologic Monitoring to Predict Brain Injury in Infants with CHD

描述（由申请人提供）：包括近红外光谱（NIRS）和扩散相关光谱（DCS）在内的新型无创光学仪器提高了我们真实的实时测量脑血流动力学和氧合的能力。脑氧合的NIRS测量已迅速被临床实践所接受，但尚未得到严格的研究。用于测量脑血流量的DCS是光学成像中的一项最新创新。结合DCS和NIRS使用，扩展了我们研究早期心脏手术后临床护理如何影响脑血流动力学和脑代谢的能力。此外，使用DCS连续评估脑血流量，我们将能够通过执行新的时间序列相关分析与平均动脉血压来评估脑自动调节。脑自动调节是一种保护机制，其被松散地定义为尽管全身血压波动但仍能维持恒定和充足的脑血流量的能力，可能由于危重疾病而变得功能障碍。使用这些新的光学仪器，我们计划研究严重形式的先天性心脏病（CHD），需要婴儿心脏手术的婴儿脑室周围白质软化症（PVL）形式的脑损伤的时间和原因。在患有CHD的婴儿中，PVL损伤发生在手术前的20%和手术后的50%以上。通过监测婴儿心脏手术后的脑组织血氧、血流和代谢，我们将研究CHD患者发生新的或恶化的PVL损伤的脑血流动力学危险因素。更好地了解这一人群中PVL的发生时间和原因将有助于医生制定治疗或预防PVL的策略。此外，从本研究中获得的知识将有助于为其他“高危”婴儿人群（如早产儿或有产伤的婴儿）设计研究。

DESCRIPTION (provided by applicant): Novel non-invasive optical instrumentation including near infrared spectroscopy (NIRS) and diffuse correlation spectroscopy (DCS) increase our ability to measure cerebral hemodynamics and oxygenation in real time. NIRS measurement of cerebral oxygenation has been rapidly accepted into clinical practice, but has not been rigorously studied. DCS for measuring cerebral blood flow, is a more recent innovation in optical imaging. Used in combination DCS and NIRS expand our capability to study how cerebral hemodynamics and cerebral metabolism are affected by clinical care following early heart surgery. Further, using DCS to continuously assess cerebral blood flow we will be able to assess cerebral autoregulation by performing new time-series correlation analysis with mean arterial blood pressure. Cerebral autoregulation is a protective mechanism loosely defined as the ability to maintain constant and adequate cerebral blood flow despite fluctuations in systemic blood pressures, may become dysfunctional as a consequence of critical illness. Using these new optical instruments we plan to study the timing and causes of brain injury in the form of periventricular leukomalacia (PVL) in infants with severe forms congenital heart defects (CHD) that require infant heart surgery. In infants with CHD the PVL injury occurs in 20% before surgery and just over 50% afterwards. By monitoring brain tissue blood oxygenation, flow, and metabolism after infant heart surgery, we will investigate the cerebral hemodynamic risk-factors for developing new or worsened PVL injury in CHD patients. A better understanding of the timing and causes of PVL in this population will help physicians build strategies to treat or prevent it. Furthermore, the knowledge gained from this study will help design studies for other 'at- risk' populations of infants, such as premature infants or infants who have had birth trauma.