Neonatal functional brain maturation in the context of perioperative critical care and pain management: A case report

Duncan Jack Hodkinson; Chandler Rebecca Lee Mongerson; Russell William Jennings; Dusica Bajic

doi:10.1016/j.heliyon.2019.e02350

Neonatal functional brain maturation in the context of perioperative critical care and pain management: A case report

Heliyon. 2019 Aug 23;5(8):e02350. doi: 10.1016/j.heliyon.2019.e02350. eCollection 2019 Aug.

Authors

Duncan Jack Hodkinson^{1

2}, Chandler Rebecca Lee Mongerson¹, Russell William Jennings^{2

3}, Dusica Bajic^{1

2}

Affiliations

¹ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Ave., Bader 3, Boston, MA.
² Harvard Medical School, 25 Shattuck St., Boston, MA.
³ Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA.

Abstract

Introduction: Remarkable plasticity during the first year of life imparts heighted vulnerability of the developing infant brain. Application of resting-state functional magnetic resonance imaging (rs-fMRI) in infants may contribute to our understanding of neuroplastic changes associated with therapeutic interventions and/or brain insults. In addition to showing clinically relevant incidental brain MRI findings, the objective of our pilot study was to test feasibility of rs-fMRI methods at this early age in the context of pediatric perioperative critical care.

Methods: We report the case of a former 33-week premature infant born with long-gap esophageal atresia that underwent complex perioperative critical care (Foker process) requiring prolonged post-operative sedation and whom presented with incidental subdural hematoma. Rs-fMRI data was acquired before (at 1-month corrected age) and after (at 2.25-months corrected age) complex perioperative care. We evaluated resting-state functional connectivity (RSFC) using graph theory to explore the complex structure of brain networks.

Results: A transient increase in head circumference coincided temporally with lifting of sedation and initiation of sedation drugs weaning, and qualified for hydrocephalus (93%) but not macrocephaly (>95%). RSFC analysis identified networks spatially consistent with those previously described in the literature, with notable pre-post-treatment qualitative differences in correlated and anticorrelated spontaneous brain activity.

Discussion: Current definitions of macrocephaly may require lower threshold criteria for monitoring of critically ill infants. Although we demonstrate that available rs-fMRI could be effectively applied in a critically ill infant in the setting of brain pathology, future group-level studies should investigate RSFC to evaluate maintenance of network homeostasis during development of both healthy and critically ill infants.

Keywords: Functional connectivity; Long-gap esophageal atresia; Neurology; Pediatrics; Resting-state; Sedation; fMRI.

Publication types

Case Reports

Grants and funding

K08 DA035972/DA/NIDA NIH HHS/United States