Shining a light on brain development

Since recording the first brain images of babies in Africa, Professor Clare Elwell (Department of Medical Physics and Biomedical Engineering, UCL) has been leading a pioneering study to increase our understanding of early brain development. Here Clare tells us about bringing a new imaging technology to a remote Gambian village, and how it could help babies suffering from malnutrition reach their full potential.

Clare Elwell with infant taking part in the BRIGHT study

Before they reach five years of age, one in four children across the globe are malnourished. There’s a lot of research showing the detrimental impact this has on their development. But we know very little about what’s going on inside their brains.

Conventional brain imaging techniques, like magnetic resonance imaging (MRI), require large, bulky and expensive scanners. Unfortunately, this technology is not available in resource-poor settings, often where malnutrition is most prevalent, and is not always suitable for very young babies.

Mapping the mind

Our technology – a technique known as Functional Near-Infrared Spectroscopy (fNIRS) – fills this gap. Using fNIRS, we can shine light into a baby’s brain and look at the colour of blood flow to different parts of the brain. By doing this we can see the changes that occur in the colour of blood flow to certain areas when the baby is doing different things, such as listening to sounds or looking at images.

Healthy active parts of the brain will appear red, reflecting well-oxygenated blood flow, when the baby is processing information. Simply by using light, we can build up a map indicating areas of brain activity and function in different babies during the first days, weeks, months and years of their lives.

Understanding brain development

Following funding from the Bill and Melinda Gates Foundation, our pilot study at the conducted at the MRC Unit The Gambia at London School of Hygiene and Tropical Medicine field station in Keneba, first demonstrated that using fNIRS was in a remote location was possible. A few years later, the BRain Imaging in Global HealTh (BRIGHT) study was born

BRIGHT study in Keneba

We’re now imaging the brains of 200 infants in The Gambia and 60 infants in the UK – from one month of age through to 24 months – and measuring their brain development.

We want to develop brain function for age curves for both Gambian and UK infants and use these to understand what a typical brain function curve looks like over the first two years of life. We know that in a percentage of our Gambian infants their physical growth will be affected by malnutrition and other risk factors

In looking at the brain function curves in these infants we may detect distinctive patterns that relate to brain development when babies are malnourished. We’re looking at as much of the brain as possible – areas linked to social skills, attention, memory, and resting state – because we just don’t know where we’re going to see a difference.

Once we understand how infants brain function and development is impacted by malnutrition and other risks, we hope to be able to target interventions more effectively. This will help us to try and protect these babies’ brains and enable them to reach their full potential.

I think the BRIGHT study is a good example of where a solution had existed for a long time, but we just didn’t know about the problem. Once I realised that understanding infant brain development in Africa was a challenge, it’s been incredibly rewarding to bring in existing technology to help.

Infant with fNIRS imaging headset in Keneba

We’d like to continue to follow our cohort and to study them in the pre-school years, so that we have a continuous measure of their brain function. I’d also really like to see the MRC field station at Keneba become a centre of excellence for infant brain development studies. Capacity building has been a large part of our project and we have been training many local field staff to conduct a whole range of infant brain development assessments. This will help us use all the skills and the talent that’s already in Africa to learn how we can optimise the methods we are using; to better understand brain development in this population; and ultimately, to ensure that all infants reach their potential in leading happy and healthy lives.

The BRain Imaging for Global HealTh (BRIGHT) study is a collaborative project, made up of a team of researchers from UCL, Birkbeck University of London, the Medical Research Council Units in Cambridge and The Gambia at London School of Hygiene and Tropical Medicine, Cambridge University and Cambridge University Hospitals.

The project is part of the Global fNIRS initiative for the use of fNIRS in global health projects and was first published in https://www.insight.mrc.ac.uk/2018/10/02/shining-a-light-on-brain-development/