New device using light could help earlier detection of brain injury in newborns

A cost-effective, portable diagnostic device being unveiled at the Royal Society Summer Science Exhibition could help reduce the likelihood of conditions such as cerebral palsy and other cognitive and behavioural disorders in babies by enabling faster, more effective diagnosis.

Developed by a team of scientists at University College London (UCL) the compact broadband near-infrared spectroscopy (NIRS) system, called CYRIL (CYtochrome-c-oxidase Research Instrument and appLication), uses an invisible, harmless near infrared light to detect signs of brain injury in newborn babies.

The light penetrates deep into the brain tissue and reflects back in real-time onto a camera. An internal computer calculates changes in light colour and tells doctors whether brain cells appear healthy or damaged. Early detection can enable faster treatment and can reduce the likelihood of permanent disability or even death.

Subhabrata Mitra, Consultant Neonatologist at University College London Hospital and the lead clinical researcher of the group, said: “It is really important to identify babies with brain injury early at the bedside so that appropriate treatment strategies can be put in place quickly to change the future outcome. CYRIL has been very promising with early results and can also have a significant impact on the cost-benefit ratio in the management of babies with brain injury within the NHS.”

A lack of oxygen and blood flow during the birthing process, also known as Hypoxic Ischemic Encephalopathy (HIE), is a dangerous condition affecting 2-3 babies out of every 1000 babies born in the UK. With cooling treatment (lowering the body temperature of the baby) many babies make a good recovery, but nearly half of them will develop cerebral palsy or cognitive and behavioural problems. It is the second most common cause of preventable childhood disability, and one in ten babies will die. It is also responsible for more than a quarter of worldwide deaths in babies.

Current medical practice means doctors have to wait for days until a newborn is stable enough to be put through an MRI machine in order to look for signs of brain injury. In contrast, CYRIL can pick up signs of injury minutes after birth, enabling treatment to be started earlier and therefore reducing the likelihood of permanent disability or even death.

MRI scans cost the NHS millions of pounds, whereas this device is priced at £50,000 and can be operated easily. It is portable enough to fit into a backpack and scientists at UCL hope that one day it could be used in lower income countries with limited access to MRI machines.

Ilias Tachtsidis, Reader of Biomedical Engineering at University College London and team leader at the Summer Science Exhibition's 'Lighting the way to a healthier brain' exhibit, said: “Doctors already use light sensors to measure tissue oxygen levels, but this gives a limited picture of the brain’s health. CYRIL goes further by using a wider, broadband spectrum of near-infrared light, hundreds of different near-infrared colours to get a much more detailed picture that includes metabolism, how much energy the brain is using. It measures changes in cytochrome c oxidase, an enzyme that changes colour as it generates energy in the mitochondria, the power factory of cells. CYRIL monitors this colour change more accurately than previous technology, giving doctors accurate information about how cells are using oxygen in real time.

“Not every hospital has an MRI machine due to the significant costs involved in purchasing and maintaining one. We hope with CYRIL we have a realistic opportunity to actually have a device in every hospital that can give information about the brain oxygenation and metabolic status at the baby’s cotside within a few hours of birth.”

The UCL team is currently running clinical studies to test the new technology’s effectiveness in improving the care of newborn babies with suspected brain injury. Preliminary results from animal studies revealed that CYRIL could predict within 20 minutes of brain injury whether or not the animal would survive.

Visitors to the Royal Society Summer Science Exhibition this week can see how CYRIL works at a replica neonatal intensive care unit built especially for the event. There will also be hands-on demonstrations showing which colours of light penetrate the body to reveal blood vessels and a chance to image your own brain oxygen and metabolism levels while doing some maths exercises.