Cambridge ‘swim cap’ gives hope to brain-injured babies

Three-week-old Theo sleeps soundly on a cot, unaware that he is helping test a new technology that could change the lives of others.

Dr. Flora Faure is gently placing a small black cap on him that looks like a swimming cap or something a rugby striker might wear.

It’s covered in hexagonal lumps that contain technology that monitors how your brain is functioning.

Researchers at Cambridge’s Rosie Maternity Hospital say they are the first in the world to trial a new technique that could speed up the diagnosis and care of 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 that light and ultrasound have been used together in this way to provide a more complete image of the brain,” says Dr. Faure, investigator of the Fusion (Functional UltraSound integrated with Optical Imaging in Neonates) study.

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

Brain injuries in newborns are a leading cause of permanent disability, and a program to reduce brain injuries in birth is currently being rolled out across the NHS.

The injury can affect the brain’s ability to communicate with the body, causing conditions such as epilepsy, which causes seizures, or cerebral palsy, which affects movement and coordination.

It is most common in premature births, but can be caused by a number of problems, including lack of oxygen, bleeding, infection, or birth trauma.

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

Explaining how the cap works, Dr Faure says: “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 take images of small blood vessels deep in the brain.”

But the device also sets itself apart because it’s portable, so you can check on babies more regularly and from the comfort of their crib.

Consultant neurosurgeon Dr Alexis Joannides believes it could have several advantages over traditional MRI (magnetic resonance imaging) or CUS (cranial ultrasound) scans.

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

“The other is that you have to take the baby to a noisy scanner, wait about 20 minutes for the scan, and then take the baby back.

“It means that realistically you can’t do a series of scans, but in those first few weeks the brain can change daily, so having a way to do repeated testing is incredibly powerful.”

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

By regularly testing babies, it is hoped that problems will be identified much earlier and therapies and interventions can begin sooner.

The charity Action Cerebral Palsy has welcomed the research.

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

“Technology like this could make a difference, but it is important that the capacity of community therapists is boosted to meet demand as there is 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 brain treatments at the ends of life: young and old.

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

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

“Understanding brain activity patterns in both full-term and premature babies can help us identify those most vulnerable to injury at an early stage.”

Theo is one of the healthy full-term babies taking part in the trial, but his mother, Stani Georgieva, finds it important to contribute.

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

Dr Joannides is also co-director of the NIHR HealthTech Brain Injury Research Centre, based in Cambridge. It exists to help develop new technologies to improve the lives of people with brain injury.

The center has funded a researcher for the study and will bring its expertise to help roll out the device across the NHS, should the study be successful.

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

“If cost allows, it could not only monitor babies with a known problem, but also be a screening tool to help identify others who may be at risk.”