Anna Zourabian

Bedside functional imaging of the premature infant brain during passive motor activation.

Abstract Background: Changes in regional brain blood flow and hemoglobin oxygen saturation occur in the human cortex in response to neural activation. Traditional functional radiologic methods cannot provide continuous, portable measurements. Imaging methods, which use near-infrared light allow for non-invasive measurements by taking advantage of the fact that hemoglobin is a strong absorber at these wavelengths. Aims: To test the feasibility of a new optical functional imaging system in premature infants, and to obtain preliminary brain imaging of passive motor activation in this population. Methods: A new optical imaging system, the Diffuse Optical Tomography System (DOTS), was used to provide real-time, bedside assessments. Custom-made soft flexible fiberoptic probes were placed on two extremely ill, mechanically ventilated 24 week premature infants, and three healthier 32 week premature infants. Passive motor stimulation protocols were used during imaging. Results: Specific movement of the arm resulted in reproducible focal, contralateral changes in cerebral absorption. The data suggest an overall increase in blood volume to the imaged area, as well as an increase in deoxyhemoglobin concentration. These findings in premature infants differ from those expected in adults. Conclusions: In the intensive care setting, continuous non-invasive optical functional imaging could be critically important and, with further study, may provide a bedside monitoring tool for prospectively identifying patients at high risk for brain injury.

Trans-abdominal monitoring of fetal arterial blood oxygenation using pulse oximetry.

Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both the fetal oxygen status and fetal tissue perfusion. Here we present the analysis for determining the most optimal wavelength selection for pulse oximetry. The wavelengths we chose as the most optimal are the first in the range of 670-720 nm and the second in the range of 825-925 nm. Further, we discuss the possible systematic errors during our measurements and their contribution to the obtained saturation results. We present feasibility studies for fetal pulse oximetry, monitored noninvasively through the maternal abdomen. Our preliminary experiments show that the fetal pulse can be discriminated from the maternal pulse and thus, in principle, the fetal arterial oxygen saturation can be obtained. We present the methodology for obtaining these data, and discuss the dependence of our measurements on the fetal position with respect to the optode assembly.

Local measurement of venous saturation in tissue with noninvasive near-infrared respiratory oximetry

We present preliminary results of non-invasive, near-infrared measurements of venous saturation (SvO2) on the leg muscle of three anesthetized piglets. We have quantified the local SvO2 by analyzing the optical spectrum of the amplitude of the absorption oscillations synchronous with breathing. To induce a variation in the muscle SvO2, we performed measurements during a protocol involving a cyclic change in the fraction of oxygen inspired by the piglet over the range 10-100% (by volume). In all three piglets, we have found a good agreement between the SvO2 values measured non-invasively with near-infrared spectroscopy (NIRS) and those measured invasively by the analysis of venous blood samples.

Theoretical considerations to optimize transabdominal monitoring of fetal arterial blood oxygenation using pulse oximetry

Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both fetal oxygen status and fetal tissue perfusion. Here we present the analysis for determining the most optimal wavelength selection for pulse oximetry. The wavelengths we chose as the most optimal are: the first in the range of 670-720nm and the second in the range of 825-925nm. Further we discuss the possible systematic errors during our measurements, and their contribution to the obtained saturation results.

Noninvasive transabdominal monitoring of fetal cerebral oxygenation using pulse oximetry

Pulse oximetry (oxygen saturation monitoring) has markedly improved medical care in many fields, including anesthesiology, intensive care, and newborn intensive care. In obstetrics, fetal heart rate monitoring remains the standard for intrapartum assessment of fetal well being. Fetal oxygen saturation monitoring is a new technique currently under development. It is potentially superior to electronic fetal heart rate monitoring (cardiotocography) because it allows direct assessment of both fetal oxygen status and fetal tissue perfusion. Here, we present feasibility studies for trans-abdominal fetal cerebral pulse oximetry. Our experiments on more than 20 patients indicate feasibility. We will present the methodology for obtaining these data, as well as a summary of our pilot clinical study.

Bedside functional imaging of the premature infant brain during passive motor activation

Changes in regional brain blood flow and hemoglobin oxygen saturation occur in the human cortex in response to neural activation. These changes create a signal that can be imaged and quantitated using various methods, most of which do not allow for continuous bedside measurements. Imaging methods using near-infrared light, however, have been described. These allow for non-invasive measurements, and take advantage of the fact that hemoglobin is a strong absorber at these wavelengths and thus acts as a naturalO contrast agent. We have generated brain functional images of ill, premature infants during passive movement of the forearm using the Boston Diffusion Optical Tomography System (DOTS), a system which allows for near real-time bedside assessments. For these initial feasibility studies in the neonatal intensive care unit (NICU), custom-made soft flexible probes were made, and passive motor tasks were performed during imaging. We found that specific passive movements of the arm resulted in focal, reproducible changes in cerebral absorption at 830 nm, indicating an increase in regional blood flow and oxygenation. Further bedside studies have since been undertaken using 780 nm and 830 nm lasers. These studies indicate that the Boston DOTS is a safe and feasible bedside near-infrared functional imaging device, and underline the importance offurther studies in this critically ill patient group at high risk for brain injury.

Functional optical imaging of visual stimulation in neonates with brain injury

Currently, outcomes in perinatal brain injury are difficult to predict. Diffuse Optical Imaging enables longitudingal assessment of regional blood flow in response to neurological stimulii. Such functional information may improve our predictive ability and guide interventions.