Development of new bedside optical imaging methods for non-invasive assessment of brain injury in neonates

新生儿的大脑特别容易受到早产、出生窒息、先天性心脏病和其他新生儿代谢紊乱的生物学后果的影响。新生儿期脑损伤和脑发育改变或延迟会带来毁灭性的神经发育后果，如严重的认知、运动、语言和行为障碍。尽管由于临床护理的进步，死亡率已经下降，但神经发育缺陷已成为最重要的合并症。目前，缺乏床边定量工具来监测和评估大脑健康是改善高危新生儿预后的关键障碍。我的方法是基于新的脑成像方法的发展，以探索和解释脑损伤和治疗对高危新生儿神经影像学数据的基本血流动力学和代谢影响。它是基于近红外和漫射相关光谱对大脑氧代谢率的非侵入性测量。与现有的技术相比，我的方法是创新和独特的，因为它可以通过提供神经元输送和消耗的氧气量的定量信息来评估床边的大脑健康。目前的技术不能提供无创脑氧代谢的直接信息，并且仅限于特定人群。***我的短期目标是开发新的床边无创脑成像方法，以改善床边血液动力学和代谢参数的床边评估。此外，将开发基于物理的新生儿神经血管对治疗反应的生物物理模型，并根据患病新生儿和健康对照组的测量数据进行验证。我的长期目标是建立正常的脑氧代谢率随年龄变化的参考图表，用于区分正常和异常的大脑发育，并预测长期结果。***无创光学技术是儿科重症监护的未来。这项工作将为一个非常重要的人群的大脑健康提供定量评估，因为长期缺陷的患病率很高。这将有助于建立我们的床边神经影像学方法作为表征新生儿背景下脑血管健康的工具。预期的结果包括更好地了解正常的大脑发育，这将允许在床边快速识别代谢异常。通过专注于发展成像方法来改善测量的量化和建模框架，我的计划将为解释新生儿的神经成像数据提供一个强大的结构。由于新生儿脑损伤是一个日益严重的问题，应该被视为国家优先考虑的问题，我的项目的影响是毋庸置疑的

The neonatal brain is particularly vulnerable to the biological consequences of prematurity, to birth asphyxia, congenital heart disease and other neonatal metabolic disorders. Brain injury and altered or delayed brain development in the neonatal period are associated with devastating neurodevelopmental consequences such as significant cognitive, motor, language and behavioural disabilities. Although mortality rates have decreased due to advances in clinical care, neurodevelopmental deficits have emerged as the most significant co-morbidity. Currently the lack of bedside quantitative tools to monitor and assess brain health is a critical barrier to improve outcome in at-risk neonates.***My approach is based on the development of novel brain imaging methods to explore and explain fundamental haemodynamic and metabolic effects of brain injury and therapy on neuroimaging data in at-risk neonates. It is based on non-invasive measure of the cerebral metabolic rate of oxygen with near infrared and diffuse correlation spectroscopies. Compared to existing techniques, my approach is innovative and unique because it allows the evaluation of brain health at the bedside by providing quantitative information on the amount of oxygen delivered and consumed by neurons. Current techniques do not provide direct information on brain oxygen metabolism non-invasively and are limited to specific populations.***My short-term objective is to develop novel bedside non-invasive brain imaging methods to improve bedside assessment of haemodynamic and metabolic parameters at the bedside. In addition, physics-based biophysical models of the neonatal neurovascular response to therapy will be developed and validated against measured data in sick newborns and healthy controls. My long-term objective aims at developing normal reference charts for the cerebral metabolic rate of oxygen with age that can be used to differentiate normal and abnormal brain development and predict long-term outcomes.***Non-invasive optical technology is the future for critical care in paediatrics. This work will provide a quantitative assessment of brain health in a very important population because of the high prevalence of long-term deficits. It will help to establish our bedside neuroimaging approach as a tool to characterize cerebrovascular health in the context of neonatology. Expected outcomes include a better understanding of normal brain development, which will allow to rapidly identify metabolic abnormalities at the bedside. By focusing on developing imaging methods to improve the quantification of measurements and a modelling framework, my program will provide a robust structure for interpreting neuroimaging data in neonates. As neonatal brain injury is a growing problem and should be considered a national priority, the impact of my program is unquestionable.**