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In this interview, Ebony chats with Rebeccah Slater, a professor of Pediatric Neuroimaging in the Department of Pediatrics (Oxford University, UK), about her research on neonatal pain perception and her involvement in FENS 2022. Slater’s lab focuses on how pain perception develops in early life and how this research can better equip doctors to manage and treat pain in babies.

At this year’s Federation of European Neuroscience Societies (FENS) Forum, BioTechniques Managing Editor, Ebony Torrington, and Digital Editor, Annie Coulson, had the opportunity to sit down with neuroimaging experts to discuss their work and the technical and clinical advances being made in neuroscience.

What will you be presenting at FENS 2022?

I’m in a workshop at FENS that is looking at several different brain imaging techniques to understand brain development in early life. Specifically, we’re discussing the development of pain perception in early life  and how we can use brain imaging to better measure pain.

What are the key imaging techniques that you use to image the neonatal brain?

There are a number of different approaches that we use. The main one we use at the cot-side is an electroencephalogram (EEG), which measures the electrical activity in the brain. We also use magnetic resonance imaging (MRI) and functional MRI (fMRI) in order to look at both the structural properties of the brain and properties related to cerebral blood flow. Additionally, we can use near infrared spectroscopy, which is somewhat similar to fMRI and also measures vascular changes rather than electrical activity.

What new approaches have you developed for measuring the efficacy of analgesics in neonates?

Fundamentally, if you want to know if somebody is in pain, you can ask but obviously, babies can’t talk and, therefore, we rely on other ways to try and measure pain. Classically, people would look at behaviors or perhaps change in heart rate, or change in oxygen saturation, in order to measure pain in babies. The problem with using behaviors, such as facial grimacing or crying facial expressions, is that they’re not very specific to pain. These behaviors could be observed if the baby is hungry, cold or wants a cuddle.

Therefore, we were trying to find more specific ways to look at pain in babies. Given that pain is a perception that occurs in the brain, it seems logical to investigate what’s happening in the brain when a baby is undergoing a painful procedure. We’ve used a variety of techniques, including near infrared spectroscopy, EEG, and fMRI, to look at the changes in brain activity that occur when a baby undergoes a painful procedure. These painful procedures are routine for infants, such as blood tests, immunizations or cannula insertions.

We’ve been able to find a pattern of brain activity that seems to be evoked by the noxious stimulus; however, we don’t see this pattern in the presence of other environmental stimuli, such as noise or light, that are equally arousing. The brain activity produced by the noxious stimuli seems to be related to the painful event. The next step was to examine whether the noxious brain activity was sensitive to analgesics, or pain relievers. So, for example, randomized controlled trials can be used to compare the noxious brain activity of babies who have and haven’t been given analgesics. If these analgesics are efficacious, then we would hope that some of the patterns of brain activity that we’re measuring in response to the noxious stimuli might be modulated or reduced. We’re also currently doing a study examining the impact of parental stroking on pain perception.

What was your inspiration for developing these new approaches for investigating neonatal pain perception?

I have always been interested in children from the very earliest stages. However, my first degree was in physics. During my first degree, I became much more interested in medical physics and was able to do projects then and in my master’s using brain imaging to better understand a whole range of clinical conditions.

When I had an opportunity to do a PhD, I really wanted to bring my interests together: brain imaging and children. There was a group at University College London(UCL; UK) that was led by Maria Fitzgerald, who had been working for a long time in the field of pain development in early life. It seemed natural for me to get involved. Introducing brain imaging into neonatal pain perception allowed us to better understand the development of a the baby’s complex emotional construct of pain.

What challenges do you face in neonatal imaging and how do you overcome them?

Working with children and hospitalized babies has challenges that you wouldn’t see in standard adult studies. And, of course, we’re talking about newborn babies; it’s a very precious time in the parents’ lives. You’ve got to be sensitive to the clinical situation and consider why these babies are in hospital in the first place.

However, there are also many opportunities to study pain in babies because infants who are in hospital often need these painful procedures to be done. This gives us the opportunity to do a little bit of extra monitoring to better understand how the baby is processing pain. So we aren’t doing anything additional that would harm the baby.

Another big challenge is, if we’re looking at newborn babies, is that we often don’t know who we are going to study the next day as the babies haven’t been born yet! New babies are born each day who might be eligible for our studies. This means, we need a big infrastructure of people already in place who are happy to do the research if parents agree to allow their children to participate.

How do you ensure that parents understand the imaging process?

All the parents are given clear information sheets written in plain English detailing the imaging and monitoring processes. What we find is that people are really fascinated by this. Especially the parents of children in intensive care whose biggest concern is often whether their baby is in pain. Because we’re trying to find better ways to measure and treat pain, they’re often really happy to take part.

What do you think will be the biggest development in neuroimaging in the next 5–10 years?

Recently, the biggest transition that we’ve seen is the shift from several small observational brain imaging studies to the creation of very large databases containing thousands or even hundreds of thousands of peoples’ brain imaging data. These large databases allow us to relate all the brain imaging information recorded in very large cohorts back to their health outcomes, prior experience and genetic factors.

We’ll start to be able to relate some of the environmental factors that have occurred in large cohorts of peoples to brain imaging in these populations. And the fact that this data is now being made openly available provides a huge opportunity for scientists to make connections in their research. It allows me to explore how early life events and development affect adulthood, for example.

Are these databases open to the public or do you require a subscription?

They don’t tend to be behind a paywall; however, you do need to have a sensible research question. This is just to make sure that the data is used in an appropriate way. The whole idea of making your data available and sharing it is becoming an important priority for both the funding bodies and the journals where we publish the work.

What are you most looking forward to at FENS 2022?

I haven’t been to a large conference for the last few years so I’m really looking forward to meeting friends and colleagues that I haven’t seen for a while. Of course, I am excited to be able to  genuinely share new ideas again in a conference setting. I think it’s a real opportunity to be creative in our thinking. When we come together, the creativity is so much richer so I hope that FENS 2022 will be an opportunity for that.

Do you have any advice for people early in their career who are presenting for the first time at FENS?

My advice for presenting at a big conference is to be really enthusiastic about your work when you talk to others who are passionate about it. It is also important to be confident and to talk to the experts. It’s an opportunity to meet people who have written papers you’ve read. Ask them questions when you can because they’re usually really willing to help, but you need to find that inner confidence to make the first connection sometimes. It is helpful to take the time to go out of your comfort zone to hear what others are working on outside your field to expand your awareness of all the brilliant research happening in neuroscience.

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