Cambridge ‘swimming cap’ brings hope for brain-injured babies

Three-week-old Theo sleeps soundly in his crib, unaware that he is helping trial new technology that could change the lives of others.

Dr. Flora Faure carefully places a small black cap on him, like a swimming cap or something a rugby forward might wear.

He is covered in hexagonal lumps containing technology that monitors how his brain works.

Researchers from Rosie Maternity Hospital in Cambridge say they are the first in the world to trial a new technique that could speed up diagnosis and care for children with conditions such as cerebral palsy, epilepsy and learning difficulties.

It could be available in UK hospitals within a decade.

“This is the first time light and ultrasound have been used together to get a more complete picture of the brain,” says Dr. Fore, an investigator on the Fusion (functional ultrasound integrated with optical imaging in newborns) study.

In the weeks before and after birth, our the brain changes every day.

Brain injury in newborns is a leading cause of lifelong disability. program to reduce traumatic brain injuries is currently being rolled out across the NHS.

Trauma can affect the brain's ability to communicate with the body, leading to conditions such as epilepsycausing convulsions, or cerebral palsywhich affects movement and coordination.

This more common in preterm births but can be caused by a number of problems, including oxygen deprivation, bleeding, infection or birth trauma.

But for the five out of every 1,000 babies who have a traumatic brain injury, current monitoring methods have difficulty predicting how and to what extent the child will be affected as they grow.

Explaining how the cap works, Dr Fore says: “Light sensors monitor changes in oxygen levels on the surface of the brain – a technique known as high-density diffuse optical tomography – and functional ultrasound allows us to visualize small blood vessels deep in the brain.”

But the device is also different in that it is portable, so it can monitor babies more regularly from the comfort of their crib.

Consultant neurosurgeon Dr Alexis Joannides believes this method may have several advantages over the traditional method. MRI (magnetic resonance imaging) or CUS (Ultrasound of the skull).

“MRI has limitations for two reasons: the first is cost and availability of scanning slots,” he explains.

“Secondly, you will have to take the child to a noisy scanner, wait about 20 minutes for the scan, and then take the child back again.

“What this really means is that you can't do a series of scans, but in those first weeks the brain can change on a daily basis, so being able to do repeated tests is incredibly powerful.”

MRI and CEUS are thought to have limited ability to predict the nature of any disorder due to the complex relationships between brain structure and function, although study led by Imperial College London reported in 2018 that accuracy could be improved with an additional 15-minute scan.

It is hoped that by carrying out regular tests on infants, problems will be identified much earlier and treatments and interventions will begin sooner.

Charity Action of cerebral palsy welcomed the study.

“For many children with cerebral palsy, the path to diagnosis is long, and families can spend years knowing their child is at 'risk' for developmental problems, but not fully understanding what that will mean,” says the organization's founder, Amanda Richardson.

“Technology like this can make a difference, but it is important that the capacity of local GP practices is increased to keep up with demand as there is already a long wait for help.”

Professor Topun Austin is a consultant neonatologist and Director of the Evelyn Perinatal Imaging Center at Cambridge University Hospital. His research focuses on treating the brain in extreme situations – in youth and old age.

He explains: “The Fusion study aims to develop and demonstrate a system for assessing brain activity in newborns and is currently the first of its kind in the world.

“We have spent 12 months successfully testing this concept in healthy and premature babies and will now focus on children considered to be at higher risk of brain damage.

“Understanding patterns of brain activity in both full-term and preterm infants can help us identify those who are most vulnerable to injury early on.”

Theo is one of the healthy full-term babies taking part in the study, but his mother, Stani Georgieva, feels it is important to do her part.

“His father and I are both scientists, and when Theo grows up he will be able to benefit from all the advances that have been made through research, so we felt it was important for him to be at least part of that understanding,” she says.

Dr. Joannides is also Co-Director NIHR HealthTech Traumatic Brain Injury Research Centerbased in Cambridge. It exists to help develop new technologies to improve the lives of people with brain injuries.

The center has funded a researcher for the study and will provide its expertise to help implement the device in the NHS if the study is successful.

“We still have hurdles to overcome, but we hope that within three to five years we will have a product that can be appreciated more widely,” he says.

“If costs allow, it could not only monitor infants with a known problem, but also serve as a screening tool to help identify others who may be at risk.”