Introducing the BRain Imaging in Global HealTh (BRIGHT) Study in Gambian Infants

Numerous risk factors can impact on a child’s brain development in the early years of life and most critically in the first 24 months. Infants in low income, resource-poor settings may be frequently exposed to a range of social, environmental, nutritional and pathological insults which can impact academic achievement and mental health into adulthood. To inform interventions which may reduce the impact of these insults, early detection of a typical neurocognitive function is required, however, there is a lack of suitable methods for use from early infancy.

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fNIRS studies being performed in a newborn, a 6-month-old infant, 13-month-old infant and a 2 yr old toddler in The Gambia.

In 2012 the Nutrition Theme was awarded a Phase I Grand Challenges Exploration (GCE) Grant from the Bill and Melinda Gates Foundation to investigate the feasibility of using an optical brain imaging technique, functional near-infrared spectroscopy (fNIRS), to provide biomarkers of brain development in young Gambian infants. fNIRS has previously been used to show that, as early as 6 months of age, infants at high risk of autism show different brain responses to socially relevant information compared to infants at low risk of autism in infants in the first year of life.The Phase I  pilot studies in Keneba provided the first brain imaging of infants in Africa and proved the efficacy of fNIRS measures of brain function in Gambian infants over the first two years of life.

sp-bright-logoAs a result, the Nutrition Theme was awarded Phase II GCE follow-on funding  in May 2015 to set up the BRain Imaging in Global HealTh (BRIGHT) study. The aim of the BRIGHT study is to combine fNIRS brain imaging with a range of other measures to deliver brain function for age curves in both Gambian and UK infants from birth to 24 months of age. These markers will be used to map the effects of pre- and postnatal insults on early brain development and provide an assessment tool for monitoring the efficacy of nutritional, and other early-life, interventions.
Recruitment of infants is due to commence in May 2016 with 200 infants being studied in The Gambia and 50 in the UK. The study will enable the development of a battery of tools incorporating neuroimaging, growth, behavioural and socio-demographic measures to chart brain development from birth to early childhood in infants from different settings. These tools will be used to generate brain function for age reference curves in Gambian and UK infants, which will allow early markers of atypical brain development to be identified and used to inform targeted intervention strategies. These reference data sets will be the first of their kind, and importantly the longitudinal birth cohorts that will be established will provide a unique opportunity to investigate the relationship between early markers of brain development and long-term cognitive and behavioural outcomes into childhood and beyond.

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fNIRS measures on a newborn infant

Spearheaded by Professor Clare Elwell (PI), Department of Medical Physics and Biomedical Engineering, University College, London. The BRIGHT project is part of the Globalfnirs initiative for the use of fNIRS in global health projects (www.globalfnirs.org). Robust, objective and cross-cultural tools for the assessment of cognitive function are urgently needed in a range of global health projects and Globalfnirs has been established to redefine what can be investigated in the developing brain of infants at risk of undernutrition and other environmental factors in resource-poor settings.

View the spotlight talk on the BRain Imaging in Global HealTh (BRIGHT) project in The Gambia during the Gates Grand Challenges meeting by Professor Clare Elwell on our youtube page on https://www.youtube.com/watch?v=gPXCIGtKYlU

The BRIGHT team includes; Dr Sophie Moore, MRC Human Nutrition Research, Cambridge; Dr Sarah Lloyd-Fox, Centre for Brain and Cognitive Development, Birkbeck, University of London; Professor Andrew Prentice, MRC International Nutrition Group, London School of Hygiene and Tropical Medicine and MRC Unit The Gambia; Dr Momodou Darboe, MRC Unit The Gambia; Sophie Budge, MRC Unit The Gambia; Christine Bartram, MRC Unit The Gambia; Perijne Vellekoop, MRC Unit The Gambia.