A newborn scanning cap that uses light and ultrasound to monitor the brain is the first of its kind in the world, researchers say.
They hope this technology will speed up the diagnosis and care of children with conditions such as cerebral palsy, epilepsy and learning disabilities.
In the imaging room at Rosie Maternity Hospital in Cambridge, eastern England, three-week-old Theo is fast asleep in his cot, unaware that he is helping to test a new technology that could change the lives of others.
Dr. Flora Faure gently places a small black cap on his head that looks like a swimming cap or something a rugby forward would wear.
The cap is covered in hexagonal protrusions, with technology to monitor brain function.
"This is the first time that light and ultrasound have been used together in this way to create a more complete picture of the brain," says Faure, a researcher on the Fusion (Functional Ultrasound Integrated with Neonatal Optical Imaging) study.
In the weeks before and after birth, our brains change every day.
Brain injuries in newborns are a leading cause of lifelong disability, and a program to reduce brain injuries at birth is currently being implemented across the UK's National Health Service (NHS).
The injury can affect the brain's ability to communicate with the body, leading to conditions such as epilepsy, which causes seizures, or cerebral palsy, which affects movement and coordination.
It is more common in premature births, but it can also be caused by a number of other problems, including lack of oxygen, hemorrhage, infection, or injury during childbirth.
For the five in every 1.000 British babies who have some kind of brain injury, current monitoring methods have trouble predicting how and to what extent the child will be affected as they grow up.
Globally, Hypoxic-Ischemic Encephalopathy (HIE) is a leading cause of death and disability among babies born at term, affecting three million babies each year.
It can be diagnosed if the baby's brain does not receive enough oxygen and/or blood around the time of birth.
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Brain injury during birth accounts for 23 percent of all newborn deaths worldwide, according to figures shared by Hope for HIE, a network for affected families.
In high-income countries, such as the US, Europe and Canada, it occurs approximately one to three times per 1.000 live births.
By comparison, low- to middle-income countries continue to have much higher case numbers, varying from approximately 4 to 26-30 cases per 1,000 live births.
The hardest-hit regions, such as parts of sub-Saharan Africa, have HIE rates of about 15 or more cases per 1.000 - almost ten times higher than in rich countries.
"Light sensors monitor changes in oxygen around the surface of the brain, a technique known as high-density diffuse optical tomography, and functional ultrasound allows us to image a small blood vessel deep in the brain," says Faure.
But the device is also different in that it is portable, so it can monitor babies more regularly, in the comfort of their crib.
Neurosurgery specialist Dr. Alexis Joanidis believes it may have several advantages over traditional MRI (magnetic resonance imaging) or CUS (cranial ultrasound) scans.
MRI has limitations for two reasons, he explains, one of which is cost and availability of scan appointments.
"The second is that you have to put the baby in a noisy scanner, wait maybe 20 minutes while it's being scanned, and then take the baby out again," he says.
"That means, realistically, you can't do a series of scans, but in those first few weeks, the brain can change on a daily basis, so having a way to do repeated tests is incredibly powerful," he adds.
MRI and CUS are also thought to have limited ability to predict the nature of any damage due to the complex relationship between brain structure and function, although a 2018 study led by Imperial College London shows that accuracy can be increased with an additional 15-minute scan.
By performing regular testing of newborns, scientists hope that problems will be identified much earlier, and that therapies and interventions can begin more quickly.
The charity Cerebral Palsy Action welcomed the research.
"For many children with cerebral palsy, the journey to diagnosis is a long one, and families can spend years knowing that their child is 'at risk' of developing the condition, but not fully understanding what that means," says its founder Amanda Richardson.
"Technology like this can make a huge difference, but it's important that the capacity of community therapists is increased to keep up with demand, as there is already a long waiting list for help," he adds.
Professor Topun Austin, a specialist in neonatology and director of the Perinatal Imaging Centre at University Hospitals Cambridge, focuses his research on treatments for the brain at its extremes in life - in great youth or deep old age.
He says the Fusion study, which aims to develop and demonstrate a system for assessing brain activity in newborns in the crib, is currently the first of its kind in the world.
"We have successfully proven the concept for 12 months with healthy and premature babies, and now we will focus on babies who are considered to be at higher risk of brain injury."
"Understanding the patterns of brain activity in both term and premature infants may help us identify those most vulnerable to injury at an early stage," he says.
Theo is one of the healthy full-term babies participating in the trial.
His mother, Stani Georgieva, believes it is important to contribute.
“Both his father and I are scientists, and when Theo grows up he will be able to benefit from all the benefits achieved through this research, so we felt it was important for him to be a small part of that understanding,” she says.
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Dr Joanidis is also co-director of the NIHR Healthtech Brain Injury Research Centre, based in Cambridge.
It exists to develop new technologies to improve the lives of people with brain injuries.
The centre funded the researcher for the study and will lend expertise to help the device be used across the NHS, if the study proves successful.
"We still have many hurdles to overcome, but we hope that within three to five years we will have a product that can be evaluated much more widely."
"If costs permit, it could not only monitor babies with a known problem, but also become a screening tool to help identify those who may be at risk," he says.
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