Pinto Carla R, Duarte João V, Dinis Alexandra, Duarte Isabel C, Castelhano João, Pinto Joana, Oliveira Guiomar, Castelo-Branco Miguel
Pediatric Intensive Care Unit, Pediatric Hospital, Coimbra Hospital and University Centre, Coimbra, Portugal.
University Clinic of Pediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Transl Pediatr. 2023 Sep 18;12(9):1646-1658. doi: 10.21037/tp-23-135. Epub 2023 Sep 11.
Functional neuroimaging can provide pathophysiological information in perinatal asphyxia (PA). However, fundamental unresolved questions remain related to the influence of neurovascular coupling (NVC) maturation on functional responses in early development. We aimed to probe the feasibility and compare the responses to multiple sensory stimulations in newborns with PA using functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS).
Responses to visual, auditory, and sensorimotor passive stimulation were measured with fMRI and fNIRS and compared in 18 term newborns with PA and six controls.
Most newborns exhibited a positive fMRI response during visual and sensorimotor stimulation, higher in the sensorimotor. An asymmetric pattern (negative in the left hemisphere) was observed in auditory stimulation. The fNIRS response most resembling the adult pattern (positive) in PA occurred during auditory stimulation, in which oxyhemoglobin (HbO) increased, and deoxyhemoglobin (HbR) decreased. Significative differences were found in the HbO and HbR profiles in newborns with PA compared to the controls, more evident in auditory stimulation. Positive correlations between the fMRI BOLD signal and at least one fNIRS channel (HbO) in all stimuli in newborns with PA were identified: the strongest was in the auditory (r=0.704) and the weakest in the sensorimotor (r=0.544); in more fNIRS channels, in the visual.
Both techniques are feasible physiological assessment tools, suggesting a distinctive level of maturation in sensory and motor areas. Differences in fNIRS profiles in newborns with PA and controls and the fMRI-fNIRS relationship observed can encourage the fNIRS as a clinically emergent valuable tool.
功能神经成像可提供围产期窒息（PA）的病理生理信息。然而，关于神经血管耦合（NVC）成熟对早期发育功能反应的影响，仍存在一些基本未解决的问题。我们旨在探讨使用功能磁共振成像（fMRI）和功能近红外光谱（fNIRS）对PA新生儿进行多种感觉刺激反应的可行性并进行比较。
用fMRI和fNIRS测量18名足月PA新生儿和6名对照对视觉、听觉和感觉运动被动刺激的反应并进行比较。
大多数新生儿在视觉和感觉运动刺激期间表现出fMRI阳性反应，感觉运动刺激时反应更强。在听觉刺激中观察到不对称模式（左半球为阴性）。PA患儿在听觉刺激期间fNIRS反应最接近成人模式（阳性），此时氧合血红蛋白（HbO）增加，脱氧血红蛋白（HbR）减少。与对照组相比，PA新生儿的HbO和HbR曲线存在显著差异，在听觉刺激中更明显。在PA新生儿的所有刺激中，fMRI血氧水平依赖（BOLD）信号与至少一个fNIRS通道（HbO）之间存在正相关：最强的是在听觉刺激中（r=0.704），最弱的是在感觉运动刺激中（r=0.544）；在视觉刺激中，fNIRS通道中的相关性更强。
这两种技术都是可行的生理评估工具，表明感觉和运动区域存在独特的成熟水平。PA新生儿与对照组fNIRS曲线的差异以及观察到的fMRI与fNIRS的关系，可促使fNIRS成为一种临床上新兴的有价值工具。
