Neurometabolic Monitoring and Imaging in Pediatric Critical Care

A special issue of Metabolites (ISSN 2218-1989). This special issue belongs to the section "Advances in Metabolomics".

Deadline for manuscript submissions: 1 June 2024 | Viewed by 4094

Special Issue Editor


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Guest Editor
Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
Interests: biomedical optics; bioinformatics; pediatric neurocritical care; extracorporeal life support; neurological injury
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Special Issue Information

Dear Colleagues,

Cerebral metabolic distress is an important primary and secondary disease process that contributes to mortality and adverse neurodevelopmental outcomes in newborns and infants. Children with neurometabolic decompensation may have severe clinical presentations, including headache, irritability, vomiting, lethargy, seizures, loss of consciousness, and death. Early detection and early intervention are invaluable to prevent irreversible neurologic injury and to achieve normal or near normal neurodevelopmental milestones. This issue aims to highlight translational advances in the quantification and imaging of cerebral metabolism and metabolic injury that may be applied in pediatric neurocritical care populations including, but not limited to, traumatic brain injury, hypoxic ischemic encephalopathy, and congenital abnormalities resulting in cardiac and/or respiratory insufficiency. The submission of original preclinical and clinical research manuscripts as well as scoping systematic and meta-analyses review articles are welcome. Please do not hesitate to reach out for further clarification. We look forward to highlighting your work in this Special Issue!

Dr. Tiffany S. S. Ko
Guest Editor

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Keywords

  • neurometabolic disorders
  • biomedical optics
  • neurological injury
  • MRI
  • cranial ultrasound
  • cerebral metabolism
  • pediatric neurocritical care
  • electroencephalography (EEG)

Published Papers (3 papers)

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Research

22 pages, 1081 KiB  
Article
Diffuse Optical Monitoring of Cerebral Hemodynamics and Oxygen Metabolism during and after Cardiopulmonary Bypass: Hematocrit Correction and Neurological Vulnerability
by Emilie J. Benson, Danielle I. Aronowitz, Rodrigo M. Forti, Alec Lafontant, Nicolina R. Ranieri, Jonathan P. Starr, Richard W. Melchior, Alistair Lewis, Jharna Jahnavi, Jake Breimann, Bohyun Yun, Gerard H. Laurent, Jennifer M. Lynch, Brian R. White, J. William Gaynor, Daniel J. Licht, Arjun G. Yodh, Todd J. Kilbaugh, Constantine D. Mavroudis, Wesley B. Baker and Tiffany S. Koadd Show full author list remove Hide full author list
Metabolites 2023, 13(11), 1153; https://doi.org/10.3390/metabo13111153 - 16 Nov 2023
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Abstract
Cardiopulmonary bypass (CPB) provides cerebral oxygenation and blood flow (CBF) during neonatal congenital heart surgery, but the impacts of CPB on brain oxygen supply and metabolic demands are generally unknown. To elucidate this physiology, we used diffuse correlation spectroscopy and frequency-domain diffuse optical [...] Read more.
Cardiopulmonary bypass (CPB) provides cerebral oxygenation and blood flow (CBF) during neonatal congenital heart surgery, but the impacts of CPB on brain oxygen supply and metabolic demands are generally unknown. To elucidate this physiology, we used diffuse correlation spectroscopy and frequency-domain diffuse optical spectroscopy to continuously measure CBF, oxygen extraction fraction (OEF), and oxygen metabolism (CMRO2) in 27 neonatal swine before, during, and up to 24 h after CPB. Concurrently, we sampled cerebral microdialysis biomarkers of metabolic distress (lactate–pyruvate ratio) and injury (glycerol). We applied a novel theoretical approach to correct for hematocrit variation during optical quantification of CBF in vivo. Without correction, a mean (95% CI) +53% (42, 63) increase in hematocrit resulted in a physiologically improbable +58% (27, 90) increase in CMRO2 relative to baseline at CPB initiation; following correction, CMRO2 did not differ from baseline at this timepoint. After CPB initiation, OEF increased but CBF and CMRO2 decreased with CPB time; these temporal trends persisted for 0–8 h following CPB and coincided with a 48% (7, 90) elevation of glycerol. The temporal trends and glycerol elevation resolved by 8–24 h. The hematocrit correction improved quantification of cerebral physiologic trends that precede and coincide with neurological injury following CPB. Full article
(This article belongs to the Special Issue Neurometabolic Monitoring and Imaging in Pediatric Critical Care)
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16 pages, 1631 KiB  
Article
White Matter Metabolite Ratios Predict Cognitive Outcome in Pediatric Traumatic Brain Injury
by Luke Berger, Barbara Holshouser, Joy G. Nichols, Jamie Pivonka-Jones, Stephen Ashwal and Brenda Bartnik-Olson
Metabolites 2023, 13(7), 778; https://doi.org/10.3390/metabo13070778 - 22 Jun 2023
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Abstract
The prognostic ability of global white matter and gray matter metabolite ratios following pediatric traumatic brain injury (TBI) and their relationship to 12-month neuropsychological assessments of intelligence quotient (IQ), attention, and memory is presented. Three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) in pediatric [...] Read more.
The prognostic ability of global white matter and gray matter metabolite ratios following pediatric traumatic brain injury (TBI) and their relationship to 12-month neuropsychological assessments of intelligence quotient (IQ), attention, and memory is presented. Three-dimensional proton magnetic resonance spectroscopic imaging (MRSI) in pediatric subjects with complicated mild (cMild), moderate, and severe TBI was acquired acutely (6–18 days) and 12 months post-injury and compared to age-matched typically developing adolescents. A global linear regression model, co-registering MRSI metabolite maps with 3D high-resolution magnetic resonance images, was used to identify longitudinal white matter and gray matter metabolite ratio changes. Acutely, gray matter NAA/Cr, white matter NAA/Cr, and white matter NAA/Cho ratios were significantly lower in TBI groups compared to controls. Gray matter NAA/Cho was reduced only in the severe TBI group. At 12 months, all metabolite ratios normalized to control levels in each of the TBI groups. Acute gray matter and white matter NAA ratios were significantly correlated to 12-month assessments of IQ, attention, and memory. These findings suggest that whole brain gray matter and white matter metabolite ratios reflect longitudinal changes in neuronal metabolism following TBI, which can be used to predict neuropsychological outcomes in pediatric subjects. Full article
(This article belongs to the Special Issue Neurometabolic Monitoring and Imaging in Pediatric Critical Care)
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16 pages, 5486 KiB  
Article
Longitudinal Evaluation Using Preclinical 7T-Magnetic Resonance Imaging/Spectroscopy on Prenatally Dose-Dependent Alcohol-Exposed Rats
by Tensei Nakano, Tomohiro Natsuyama, Naoki Tsuji, Nanami Katayama, Junpei Ueda and Shigeyoshi Saito
Metabolites 2023, 13(4), 527; https://doi.org/10.3390/metabo13040527 - 06 Apr 2023
Cited by 2 | Viewed by 1122
Abstract
Prenatal alcohol exposure causes many detrimental alcohol-induced defects in children, collectively known as fetal alcohol spectrum disorders (FASD). This study aimed to evaluate a rat model of FASD, in which alcohol was administered at progressively increasing doses during late pregnancy, using preclinical magnetic [...] Read more.
Prenatal alcohol exposure causes many detrimental alcohol-induced defects in children, collectively known as fetal alcohol spectrum disorders (FASD). This study aimed to evaluate a rat model of FASD, in which alcohol was administered at progressively increasing doses during late pregnancy, using preclinical magnetic resonance (MR) imaging (MRI) and MR spectroscopy (MRS). Wistar rats were orally administered 2.5 mL/day of ethanol (25% concentration) on gestational day 15, and postnatal fetuses were used as FASD models. Four groups were used: a control group (non-treatment group) and three groups of FASD model rats that received one, two, or four doses of ethanol, respectively, during the embryonic period. Body weight was measured every other week until eight weeks of age. MRI and MRS were performed at 4 and 8 weeks of age. The volume of each brain region was measured using acquired T2-weighted images. At 4 weeks of age, body weight and cortex volume were significantly lower in the three FASD model groups (2.5 × 1: 304 ± 6 mm3, p < 0.05; 2.5 × 2: 302 ± 8 mm3, p < 0.01; 2.5 × 4: 305 ± 6 mm3, p < 0.05) than they were in the non-treatment group (non-treatment: 313 ± 6 mm3). The FASD model group that received four doses of alcohol (2.5 × 4: 0.72 ± 0.09, p < 0.05) had lower Taurine/Cr values than the non-treatment group did (non-treatment: 0.91 ± 0.15), an effect that continued at 8 weeks of age (non-treatment: 0.63 ± 0.09; 2.5 × 4: 0.52 ± 0.09, p < 0.05). This study is the first to assess brain metabolites and volume over time using MRI and MRS. Decreases in brain volume and taurine levels were observed at 4 and 8 weeks of age, suggesting that the effects of alcohol persisted beyond adulthood. Full article
(This article belongs to the Special Issue Neurometabolic Monitoring and Imaging in Pediatric Critical Care)
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