Optical Brain Monitoring Predicts Neurodevelopmental Outcomes in Preterm Infants

Premature birth, defined as delivery before 37 weeks of gestation, increases the risk of language, motor, and cognitive delays, yet many late preterm infants receive limited follow-up. Clinicians currently lack an easy bedside method to anticipate which babies may need early interventions after discharge. Early identification is critical because developmental deficits may not be apparent in the neonatal intensive care unit. Researchers have now demonstrated a noninvasive optical neuromonitoring approach that estimates cerebral oxygen use in preterm infants and predicts later development.

Scientists at Université de Montréal (UdeM) and its affiliated children’s hospital, Santé Québec—CHU Sainte-Justine, evaluated a combined optical technique using FDNIRS and DCS. A small sensor placed on the infant’s forehead measures cerebral blood flow and oxygen delivery, as well as oxygen extraction and consumption. The method is painless, uses no radiation, is performed at the baby’s bedside in intensive care, and requires no sedation.

In a study of 241 infants born between 29 and 36 weeks’ gestation, the team recorded brain measurements at term-equivalent age, approximately 40 weeks. Neurodevelopment at age two was assessed using the Bayley-4 scales. The key finding was that more efficient cerebral oxygen use was associated with better subsequent cognitive and language performance. Nearly one in three children showed delay in at least one domain, and average cognitive and language scores for the cohort were slightly below the normative mean. The findings were published in January in Scientific Reports.

Sex-specific analyses indicated greater vulnerability among boys. Associations between the optical brain measures and later outcomes were stronger in males than in females. Boys also had lower language scores (92 vs. 99) and motor scores (98 vs. 101), underscoring the need for sex-adapted monitoring in this population.

Related work applied the same neuromonitoring in 30 newborns with d-transposition of the great arteries within 72 hours after corrective cardiac surgery. Compared with healthy infants, affected newborns showed lower cerebral oxygen delivery, and higher postoperative blood flow and delivery were linked to better motor and language scores at age two. These findings, published in January in the Journal of Cerebral Blood Flow & Metabolism, support the technique as an early biomarker in congenital heart disease.

The research team is extending follow-up beyond age two, completing data collection at age five and preparing proposals for assessments at age eight. They are also developing normative charts for brain oxygen availability and utilization and working toward real-time bedside analysis.

“We don’t yet fully understand why some premature infants show lower oxygen metabolism. But we believe that premature birth during the third trimester, a critical period of brain development, may affect the metabolic demand needed to support this rapid and increased maturation,” said Mathieu Dehaes, who conducts his research at Santé Québec—CHU Sainte-Justine’s Azrieli Research Centre.

“This tool could help identify very early which babies need specialized follow-up or early interventions to optimize their development,” said Thuy Mai Luu, medical director of CHU Sainte-Justine’s neonatal follow-up program. “If a developmental delay is suspected, that’s where physiotherapists, occupational therapists and, later, speech-language pathologists can step in.”

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Université de Montréal
Santé Québec—CHU Sainte-Justine