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Lighting the way to better baby care

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The brain injury technology University College London has been working on for eight years looks decidedly unremarkable.

Barely noticeable in the neonatal skyline of equipment is a trolley housing a laptop and what looks like a projector.

Yet the data it offers clinicians could accelerate improved care for brain injured babies in their crucial first few days. Currently, when babies suffer brain injury at or soon after birth due to lack of oxygen to the brain, doctors must wait several days until the newborn is stable enough for an MRI scan. Only then, usually at least four days after the birth, can they detect and assess the injury.

In these days before the MRI, there is poor visibility on whether treatments are working or how severe the injury may be.

But a new device, which has now passed a feasibility test involving over 50 babies with hypoxic-ischemic encephalopathy, could close this window of missed opportunity.

Dr Ilias Tachtsidis, biomedical engineer and team leader on the project, explains: “We wanted to know, from day one, what is happening to the biochemistry of the brain tissue in these babies. EEG shows how well the brain is doing in terms of the neuronal activity but it doesn’t show anything about how well the brain is getting oxygen or using it to produce energy.

“The other instrument at the doctors’ disposal is the MRI, but it is very difficult to take a sick, one-day-old baby for an MRI scan. The challenge was to develop a device that we can use immediately after the baby is born to inform the clinical team about the brain health of that baby.”

UCL engineers, doctors and scientists have combined forces in overcoming this challenge since 2010 – supported by funds from the Welcome Trust and access to UCL Hospital. The product of their endeavours is a seemingly transformative piece of cotside kit for neonatal intensive care wards.

Its magic is made possible through a technology that started life in the late seventies and has since emerged as a game- changer in internal body monitoring. Broadband near-infrared spectroscopy uses light with wavelengths just beyond the red end of the rainbow and is invisible to the eye. This near infrared light can travel far into the body – even through bone – while other colours with shorter wavelengths are absorbed and don’t pass through.

Light can reveal changing oxygen levels in the blood pumping through arteries and veins. Certain molecules in the brain, such as oxygen-carrying chemicals in the blood and cytochrome c oxidase in mitochondria, change colour depending on their activity and oxygen levels.

Different colour molecules absorb and reflect different colours of light, so by measuring the colours of the light passing through the brain, it is possible to work out the volume and activity of these molecules.

This data shows doctors which areas of the brain are working properly or have been damaged due to a lack of oxygen.

In the device, near-infrared light travels down optical fibres and is shone on the baby’s head. Some of it passes through the skull and brain and comes back to the surface.

This returning light is picked up by another optical fibre and travels to a spectrometer, which measures the relative amounts of different coloured light in the beams.

The light is then split into a spectrum of its constituent colours, using a prism or ‘diffraction grating’. Then a camera detects the amounts of each colour of light.

Finally, a computer calculates changes in the way certain parts of the brain are using oxygen and generating energy, giving a readout of brain metabolism and activity.

Tachtsidis says: “Our feasibility study has shown that the measurements can identify and classify newborn babies from day one; which ones are going to have a severe brain injury? Which will have severe or mild neuro- development issues?

“Our technology has shown a very high specificity in terms of classifying where the babies are going to be at two years old and five years old, for example. Are they going to have neurodevelopment issues, cerebral palsy or cognitive issues? We can identify this in babies from day one.”

Given that the device is cheap, cotside, non- invasive and harmless, industry parties are understandably circling; and Tachtsidis is hopeful of an eventual mainstream roll-out. It could take several years, however.

“Launching a medical device is a long process that requires a lot of regulation. We’ve had quite a few phone calls asking about
the device from various industry players, especially those interested in intensive care. I am hoping, with the help of UCL, we can manage to disseminate the value of this technology to the industry and get closer to a widely-available device.”

Next on UCL’s immediate agenda is figuring out how the data generated by the technology can influence better outcomes for brain injured newborns.

“We have a long way to go,” he says. “We still have to test how we can use this technology to manage treatment. We now have technology that, very early on, can prognosticate the impact of the brain injury on the baby.”

According to the National Neonatal Database, around three in 1,000 babies born in England suffer brain injury at or soon after birth, due to lack of oxygen during delivery. In the US, this figure is estimated at between one and six. More than half of affected newborns will develop disabilities, while one in 10 dies.

The risk is higher in babies born before 37 weeks, where up to 26 in 1,000 babies are affected. The standard approach in hospitals is to cool the baby’s body temperature to slow their metabolic processes.

Often, babies are placed on a water-filled cooling blanket and monitored over several days. An IV may help to further reduce body temperature. According to one prominent expert in the field, Dr. Inder of Washington University School of Medicine, “neonatal therapeutic hypothermia can reduce the chance of severe brain injury by 25 per cent in term-born babies with poor transition or low Apgar scores after birth”.

Since the treatment is not effective in every baby, however, Tachtsidis believes the new light technology could save time by quickly identifying which newborns are not benefitting from it.

“The clinical team needs to know very early on if this is not working for the infants to decide what else they can do about [the injury]. They need a measurement that enables this.”

There are various hurdles to get through before UCL’s technology is commercially available to hospital management. “Clearly we are looking at how we can disseminate our work and roll it out to more hospitals.

“We also need to build a demonstrator unit and, once we have that, we can move towards a clinical trial. There may also be some education required in terms of helping clinicians to understand the data and act on it.”

If UCL’s bright minds can prove to the world that their creation is a worthy addition to the hospital cotside, it could be a revelation in brain injury care.

The impact of a brain injury at birth due to decreased oxygen (hypoxia) and blood flow (ischemia) can lead to intensive, life-long care needs. Speeding up the immediate response time to unfolding events in the brain might change the life trajectory of newborns.

In the UK, the healthcare sector’s approach to baby brain injury risk has been a contentious issue in recent years. In some quarters, the drive for natural births has been blamed for a seeming rise in maternity ward injuries.

Last year the Royal College of Midwives formally announced it had discontinued its 12-year campaign for normal births without medical intervention.

Meanwhile, a 2017 study by the Royal College of Obstetricians and Gynaecologists suggests that most baby brain injuries in labour are avoidable.

It analysed 1,136 stillbirths, neonatal deaths and brain injuries on UK maternity wards in 2015. Three quarters of the babies – 854 of which suffered a brain injury – might have had a different outcome if they had received different care, researchers said.

While baby brain injury is a medical issue that can have a profound effect on families, their financial impact is also under scrutiny.

A report by NHS Resolution last year showed that compensation claims for new-borns with brain injuries or cerebral palsy soared 23 per cent in 2016/17 to 232. Their collective claim value was £1.9bn. It is predicted that the per- child claim value could soon hit £20m, NHS Resolution said.

For all concerned – families, the NHS, neonatal professionals and, of course, the tiny patients who will enter the world fighting for survival – much is riding on the success of UCL’s promising project.

Find out more at www.metabolight.org

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Brain injury

Olympic champion Tom Daley appeals for funding for ‘groundbreaking’ brain tumour drug

Olympic champion diver, Tom Daley joins Brain Charity to appeal for funding for a groundbreaking cannabis drug trial for brain cancer

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Olympic champion Tom Daley in a black tuxedo promoting a new trial into cannabis based drugs for brain cancer

Tom Daley has joined The Brain Tumour Charity appeal to call for more funding for a ‘groundbreaking’ trial of a cannabis-based drug that could help to treat an aggressive form of cancer.

The Olympic champion lost his father, Robert who died from a brain tumour aged 40 in 2011.

The appeal by the Brain Tumour Charity hopes to raise the £450,000 which is needed to fund the three-year trial. It will begin recruiting 232 patients at 15 hospitals across the UK early next year.

Olympic champion support

In a video, Tom said: “We are reaching out to all you individual heroes and supporters, to help fund this groundbreaking trial. When you donate, you’ll receive a link for your social media badge of honour. Join our community, spread the word and help us pave the way to beating brain tumours”.

Tom has been advocating and campaigning for charity since the loss of his father. He recently raffled off a jumper he made helping to raise £5,787 in 14 days. The Olympic champion diver was seen knitting a dog sweater at one of the recent swimming events. He took up knitting to help with his mental health and stress during lockdown.

Read more about the study here

The study

The study led by the University of Leeds and coordinated by the Cancer Research UK Clinical Trials Unit at the University of Birmingham will examine if adding Sativex to chemotherapy could extend life for people diagnosed with recurrent glioblastoma or delay the progression of the disease. Sativex is a cannabis-based drug normally prescribed to MS patients.

If the trial is successful, it could be one of the first additions to NHS treatment for glioblastoma patients in more than a decade.

The condition is one of the most common and aggressive forms of brain cancer. There are currently 2,200 people diagnosed in England each year.

Read more: Study suggests long-term Covid symptoms could be rare in school-age children

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Dementia

Could our driving help to diagnose Alzheimer’s Disease?

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A person driving while holding the steering wheel with both hands

Researchers have combined Global Positioning System-based (GPS) with AI to detect early-onset Alzheimer’s in drivers, revealing a high level of accuracy in diagnosis.

The DRIVES Study at Washington University in St. Louis, led by Catherine Roe and Ganesh Babulal and funded by the National Institute on Aging.

They proposed that those who had been diagnosed would make different decisions when driving in comparison to those without the disease. Alzheimer drivers may drive for shorter periods of time, stick to commonly used routes, travel less at night and make abrupt changes to their driving.

AI has the advantage of being able to read from large amounts of cases and diagnoses without bias or judgement. It is thought that this could lead to more correct diagnosis.

Read more: Supercomputer enables new levels of brain insight

The study

Researchers selected 139 people in Missouri US to have a GPS unit installed in their cars for one year. The data collected was fed into a custom AI system designed using Python to assess patterns in driving.

Half of the selected individuals had already been diagnosed with Alzheimer’s while the other half were healthy. Those in the positive group had been tested using medical methods such as spinal fluid tests and PET scans.

Driving results

The results of the experiment showed a detection accuracy of 82 per cent. The model was more accurate still (90%) when it also added in the results of a genetic test for Alzheimer’s known as apolipoprotein E (APOE) genotyping that indicates whether you may have an inherited risk for the disease.s. It was noted that all participants were over the age of 65 which means the study may not work on younger people who do not have symptoms.

Larger, randomised studies are needed to show a definitive link between the detected driving behaviours and preclinical Alzheimer’s disease.

The US National Institute on Aging says family members might eventually notice that their loved one is taking longer to complete a simple trip, has been driving more erratically, or gets muddled over which pedal is which, for example.

Read more: Maximum of 10 headers a week in football training, the new guidance recommends

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More headlines

More retired rugby players report concussion than any other injury

Concussion is the most common injury among retired rugby athletes, according to new research.

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Researchers from Durham University and Auckland University of Technology compared the injuries of retired rugby athletes with retired non-contact athletes.

They found that retired elite rugby athletes reported up to seven times the number of injuries than those who played amateur rugby and non-contact sports, and concussion was the most commonly reported injury, and had the most common recurrence, for both groups of rugby players compared to non-contact athletes.

Among retired rugby athletes, 81 per cent of elite and 76 per cent of amateur players reported at least one concussion, and concussion injury had the highest recurrence.

The rugby athletes, who were all code athletes, which means they played rugby union or rugby league, were also up to 10 times more likely to report experiencing a lasting impact of previous concussion, among other injuries, including back and joint pain.

The researchers concluded that past participation in rugby union and rugby league, particularly at elite level, is linked to a higher risk of cumulative injuries and a continued impact of previous injuries after retiring from the game.

Retired elite rugby code players reported that previous concussions had a negative impact on their current health, the researchers found.

They urge that there should be more efforts to reduce injuries in rugby codes at all levels, given such a high number of concussions.

“The monitoring of injuries at the player level rather than at club level could be one approach to improving the management of injury for individualised player welfare,” the paper, published today in the journal Sports Medicine, states.

“This could include a system by which the individual player’s injury history can be followed as they move across professional club contracts, and specific strength and conditioning and sports therapy strategies prescribed to help prevent recurrence of injury.”

This is the first study to examine total injuries across entire careers of contact sport athletes, according to the researchers, and the reported effects on physical wellbeing post-retirement.

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