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Title: Predictive role of cytochrome C oxidase measured by broadband near infrared spectroscopy as a real-time biomarker of newborn brain injury
Author: Mitra, Subhabrata
ISNI:       0000 0004 7660 3713
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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Perinatal brain injury causes significant mortality and morbidity. Hypoxic ischemic (HI) brain injury is the commonest cause for early neonatal encephalopathy (NE) with other common causes being neonatal stroke and neonatal seizures. There is an urgent need for an early real-time cot side biomarker of perinatal brain injury. Near infrared spectroscopy (NIRS) provides continuous information regarding the changes in cerebral oxygenation and hemodynamics. Broadband NIRS can also reflect the status of mitochondrial function with changes in cytochrome c oxidase concentration (CCO). The aim of this work was to investigate the role of CCO in term infants following acute brain injury to improve the understanding of background pathophysiology and outcome prognostication in neonatal intensive care. This work primarily aims to investigate infants with hypoxic ischemic encephalopathy (HIE), but also explores the changes in brain metabolism and haemodynamics during neonatal seizures and following perinatal stroke. Thirty-seven infants with HIE and one infant following suspected perinatal stroke were investigated. During cooling, a metabolic reactivity index between [oxCCO] and mean arterial blood pressure at 48h of life correlated with outcome biomarkers and differentiated between infants with good and poor outcome. During rewarming period, the relationship between the cerebral oxygenation and metabolism correlated with the injury severity noted on electrical activity at presentation. Following neonatal stroke, repetitive, transient changes in cerebral oxygenation, hemodynamics and metabolism were identified; a different relationship between oxygenation and metabolism was evident between two hemispheres. Marked changes in cerebral metabolism, oxygenation and haemodynamics were also identified during neonatal seizures. These results indicate a promising role of CCO monitoring in perinatal brain injury.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available