Functional Near-Infrared Spectroscopy (fNIRS) Based Functional Connectivity Alterations Associated with Delirium in Critically Ill Children: An Exploratory Study

This study evaluated whether functional near-infrared spectroscopy (fNIRS)-derived functional connectivity (FC) could serve as a neurophysiological marker of delirium in critically ill children. We conducted a prospective observational study in a tertiary pediatric intensive care unit (PICU) in London, Ontario, involving 28 children aged 1 month to 18 years. Delirium status was determined using the validated Cornell Assessment of Pediatric Delirium (CAPD) score or based on clinician diagnosis in neuro-atypical children. Behavioural assessments also included the FLACC scale for pain and COMFORT-B for level of sedation and/or comfort. A total of 31 resting-state fNIRS recording sessions were collected at the bedside, including 11 during delirium. As anticipated, CAPD scores were higher during delirious fNIRS recordings compared to non-delirious ones on average. Generalized estimating equation (GEE) modelling revealed that increased functional connectivity between the right temporal and left temporoparietal regions was independently associated with delirium presence, even after false discovery rate (FDR) correction. Sedative opioid use also emerged as a significant predictor of delirium status. In a separate model examining delirium severity, higher CAPD scores were associated with greater sedative opioid exposure, younger age, and developmental delay. However, functional connectivity was not independently associated with delirium severity after correction for multiple comparisons. These findings suggest that fNIRS-derived FC may offer an objective, brain-based biomarker of delirium presence in pediatric critical care, with potential to complement existing behavioural assessment tools.

Name thesis:degree_name

M Sc

Discipline thesis:degree_discipline

Neuroscience

Grantor dc:publisher

The University of Western Ontario

Year dc:date.issued

2025

Author dc:creator

• Krivoruk, Brian

Advisors dc:contributor.advisor

• Ganesan, Saptharishi Lalgudi
• Duerden, Emma

• Delirium
• Pediatric Intensive Care Unit
• Functional Connectivity
• fNIRS
• Children
• CAPD

Statement dc:rights

• Attribution-NonCommercial-NoDerivatives 4.0 International

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/20.500.14721/39203

OAI identifier oai:identifier

oai:uwo.scholaris.ca:20.500.14721/39203