Projects

Our laboratory studies many different forms of neonatal brain injury, focusing on pathophysiology, biomarkers, prediction modeling, and neuroprotection strategies.

Intraventricular hemorrhage

Intraventricular hemorrhage (IVH) is the most common form of brain injury in infants born before 28 weeks of gestation. Our lab is currently investigating how disturbances in perfusion alter the risk for IVH. In particular, this work focuses on models of cerebrovascular autoregulation using simultaneous collection of physiology data in conjunction with near-infrared spectroscopy measurements of cerebral perfusion. Recently we published a novel measurement of autoregulation which demonstrates that autoregulation improves with maturation and infants with IVH have impaired autoregulation.

 
 

White matter injury

White matter injury, also called periventricular leukomalacia, is another common form of brain injury in premature neonates, born before 28 weeks of gestation and is linked to the subsequent development of cerebral palsy. Our lab has developed new approaches to the quantification of white matter injury on MRI, prediction of white matter injury using EEG and longitudinal evaluation of cerebral blood flow disturbances and the development of white matter injury. Recent work by our lab has demonstrated that a simple, limited channel bedside EEG is capable of predicting white matter injury on MRI

 

Hypoxic ischemic encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is the most common form of brain injury affecting term born neonates and results from a temporary reduction in cerebral blood flow during the perinatal period. Our research investigates HIE from a number of different angles including a new approach to brain MRI scoring, validated against long-term follow-up data, investigation into dysfunction of the cerebrovascular autoregulatory system in HIE, and new extensions of the neuroprotective treatment, therapeutic hypothermia in new patient populations than previously studied. We are also a recruiting center for the multicenter trial of EPO for neuroprotection in HIE and form the neuroimaging core (with Bob Mckinstry MD, PhD) for the study that will include 500 infants.


Seizures

Infants are at a higher risk for seizures than at any other period in the human lifespan, yet many seizures are unrecognized and not treated. Our work has also investigated the use of EEG technology in term infants with HIE, noting that the use of empiric EEG monitoring reduces the seizure burden and may be related to improved outcomes. We have an additional line of investigation looking at seizures in preterm infants, including detection and linkage to subsequent brain injury.

 

Retinopathy of prematurity

Retinopathy of prematurity (ROP) is a common form of visual impairment in premature neonates. Although the development of ROP has been linked to oxygen exposure, previous trials have failed to demonstrate a consistent, reproducible measure for assessing risk. Recent work done by our lab developed a new, multimodality approach for measuring oxygenation which has shown promised in reliably predicting the risk of ROP, as compared to existing technology.

 

Cerebral Autoregulation

The autoregulatory system regulates the cerebral vasculature to smooth fluctuations in systemic blood pressure and provide a consistent cerebral perfusion pressure.  We have developed models demonstrating dysfunction of this system in the setting of prematurity and after hypoxic-ischemic injury and linked this to the development of subsequent brain injury.

 

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