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.

Public Health Relevance

This project aims test how non-invasive optical monitoring can be used to predict white matter injury in the post-operative infant with severe congenital heart defects. Understanding the timing and etiology of the injury will lead to targeted interventions that can be applied to larger populations of infants at risk for similar white matter injury.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS072338-03
Application #
8516123
Study Section
Acute Neural Injury and Epilepsy Study Section (ANIE)
Program Officer
Hirtz, Deborah G
Project Start
2011-08-01
Project End
2016-07-31
Budget Start
2013-08-01
Budget End
2014-07-31
Support Year
3
Fiscal Year
2013
Total Cost
$316,660
Indirect Cost
$77,123
Name
Children's Hospital of Philadelphia
Department
Type
DUNS #
073757627
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Busch, David R; Lynch, Jennifer M; Winters, Madeline E et al. (2016) Cerebral Blood Flow Response to Hypercapnia in Children with Obstructive Sleep Apnea Syndrome. Sleep 39:209-16
Wernovsky, Gil; Licht, Daniel J (2016) Neurodevelopmental Outcomes in Children With Congenital Heart Disease-What Can We Impact? Pediatr Crit Care Med 17:S232-42
Hawks, Charlotte; Jordan, Lori C; Gindville, Melissa et al. (2016) Educational Placement After Pediatric Intracerebral Hemorrhage. Pediatr Neurol 61:46-50
Jalali, Ali; Rehman, Mohamed; Lingappan, Arul et al. (2016) Automatic Detection of Endotracheal Intubation During the Anesthesia Procedure. J Dyn Syst Meas Control 138:1110131-1110138
Kirschen, Matthew P; Dori, Yoav; Itkin, Maxim et al. (2016) Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis. J Pediatr 176:200-3
Lynch, Jennifer M; Licht, Daniel J (2016) First things first: The importance of the preoperative period for neurocognitive outcomes in hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 151:1367-8
Licht, Daniel J (2016) Brain hypoxia before surgery; a tale of two cells: Astrocytes and oligodendrocytes. J Thorac Cardiovasc Surg 151:273-4
Licht, Daniel J (2015) The path forward is to look backward in time: fetal physiology: the new frontier in managing infants with congenital heart defects. Circulation 131:1307-9
Wu, J; Awate, S P; Licht, D J et al. (2015) Assessment of MRI-Based Automated Fetal Cerebral Cortical Folding Measures in Prediction of Gestational Age in the Third Trimester. AJNR Am J Neuroradiol 36:1369-74
Fogel, Mark A; Li, Christine; Wilson, Felice et al. (2015) Relationship of cerebral blood flow to aortic-to-pulmonary collateral/shunt flow in single ventricles. Heart 101:1325-31

Showing the most recent 10 out of 45 publications