Early brain monitoring of infants with prenatal opioid exposure using quantitative diffuse optical spectroscopy

Trustees Of Indiana University, Bloomington IN

Investigators

Abstract

Abstract The incidence of infants with prenatal opioid exposure (POE) has increased significantly in the last decade. Infants exposed to opioids prenatally are at risk for poor cognitive, behavioral, and neurodevelopmental outcomes later in life. Moreover, a large percentage of infants with POE exhibit a broad variety of neonatal opioid withdrawal symptoms (NOWS) that range from mild to severe. Currently, there is no objective strategy to identify severity and/or guide clinical intervention for NOWS, leading to prolonged hospital stays and delayed treatment. The absence of a unified management strategy is partly due to a lack of quantitative tools to objectively identify NOWS biomarkers in the first days of life. MRI studies linking brain abnormalities with prenatal opioid exposure suggest that cerebral physiology could serve as an early biomarker, but logistical challenges limit its use. Optical techniques like near-infrared spectroscopy (NIRS) offer a non-invasive and cost-effective alternative, but commercial devices are limited in providing a comprehensive profile of cerebral physiology. This project proposes using a novel hybrid device that combines frequency-domain NIRS (FD-NIRS) and diffuse correlation spectroscopy (DCS) to quantify cerebral oxygenation and cerebral blood flow in neonates. While similar in concept and ease of use to standard FDA- approved cerebral oximeters, our approach is more advanced because it can estimate cerebral oxygen metabolism by combining cerebral oxygenation and cerebral blood flow measurements. In this study, we propose to acquire longitudinal FD-NIRS/DCS measurements on infants with POE and controls to determine early differences in cerebral physiology in the first week of life (Aim 1), evaluate their associations with short-term clinical outcomes (Aim 2), and monitor potential changes in cerebral physiology in response to pharmacologic treatment for severe NOWS (Aim 3). No prior study has assessed the potential of bedside measures of cerebral physiology to screen neonates with POE and/or NOWS. Successful completion of our research will offer new insights into the underlying pathophysiology of early brain changes resulting from POE and demonstrate the prognostic value of longitudinal FD-NIRS/DCS measurements for early assessment of NOWS severity in individual neonates. This could potentially improve symptom monitoring and guide personalized treatment, ultimately enhancing the care of newborns with NOWS.