Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 1 , ISSUE 3 ( July-September, 2007 ) > List of Articles


Fetal Neurology—Lesson Learned and Future Challenges

Berivoj Miskovic, Guillermo Azumendi, Asim Kurjak, Lara Spalldi

Keywords : Neurobehavioral development,Fetal behavior,Four- dimensional ultrasound

Citation Information : Miskovic B, Azumendi G, Kurjak A, Spalldi L. Fetal Neurology—Lesson Learned and Future Challenges. Donald School J Ultrasound Obstet Gynecol 2007; 1 (3):26-36.

DOI: 10.5005/jp-journals-10009-1105

License: CC BY-NC 4.0

Published Online: 01-09-2008

Copyright Statement:  Copyright © 2007; The Author(s).


Neurological failure is the most apprehension complication of pregnancy, labor and the neonatal period. The origin and outcome correlation is frequently doubtful. The arrival of four-dimensional ultrasonography (4D US) and its function to study fetal behavior patterns have initiated to offer insight into the structural and functional fetal brain development. Although many fetal behavioral studies have been conducted, it is still questionable whether the assessment of continuity from fetal to neonatal behavior could improve our ability of early detection of brain pathology. Neurological assessment of fetus in utero is extremely difficult even having such sophisticated equipment like 4D ultrasound. As it is well known that quantity of GMs is not so informative and predictive for neurological impairment, their quality should be assessed. Gestalt perception of premature GMs we are dealing with in utero and several weeks postnatally are not as predictive for the detection of neurologically abnormal fetuses or newborns as fidgety GMs. Therefore some additional parameters should be added to the prenatal neurological examination in order to improve our ability to make the distinction between normal and abnormal fetuses.

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  1. New data about embryonic and fetal neurodevelopment and behaviour obtained by 3D and 4D sonography. J Perinat Med 2005;33:478-90.
  2. Development of the nervous system. In Polin RA, Fox WW (Eds): Fetal and neonatal physiology. Philadelphia-London-Toronto-Montreal-Sydney-Tokyo: WB Saunders Copmany 1992;1491-1509.
  3. Minireview: Summary of the initial development of the human central nervous system. Teratology 1999;60:39-41.
  4. Ontogenesis of goal-directed behavior: anatomo-functional considerations. Int J Psychophysiol 1995;19:85-102.
  5. Determination and differentiation in the development of the nervous system. In Kandel ER, Schwartz JH (Eds): Principles of Neural Science 2nd ed. New York: Elsevier Science Publishing 1985:730-2.
  6. Prenatal development of nucleus basalis complex and related fibre system in man: a histochemical study. Neuroscience 1986;17:1047-77.
  7. Onset of synapse formation in the human spinal cord. J Comp Neurol 1981;10;201:211-9.
  8. Zentralnervensystem. In Hinrichsen KV (Ed): Humanembryologie. Berlin: Springer-Verlag, 1990;381-448.
  9. Ultrasound studies of human fetal behaviour. Early Hum Dev 1985;2:91-8.
  10. Ultrasonographic study of fetal movements. Semin Perinatal 1981;4:175-81.
  11. Early movements are useful for estimating the gestational weeks in the first trimester of pregnancy. In Levski RA, Morley P, (Eds): Ultrasound ’82. Oxford: Pergamon Press, 1983;577-82.
  12. Fetal brain and cognitive development. Dev Rev 1999;20:81-98.
  13. The emergence of fetal behavior I. Qualitative aspects. Early Hum Dev 1982;7:301-22.
  14. Development of prestriate visual projections in the monkey and human fetal cerebrum revealed by transient cholinesterase staining. J Neurosci 1984;4:25-42.
  15. Spontaneous motor activity in the normal fetus. Early Human Dev 2001;65:139-44.
  16. Is neurological assessment of the fetus possible? Eur J Obstet Gynecol Reprod Biol 1997;75:81:4.
  17. Classification and quantitative aspects of fetal movements during the second half of pregnancy. Early Hum Dev 1991;25:19-35.
  18. Early Hum Dev 1990;23:151-8.
  19. Fetal hand movements and facial expression in normal pregnancy studied by four-dimensional sonography. J Perinat Med 2003;31:496-508.
  20. Assessment of fetal behavior and general movements by four-dimensional sonography. Ultrasound Rev Obstet Gynecol 2004;4:103-14.
  21. The potential of four-dimensional (4D) ultrasonography in the assessment of fetal awareness. J Perinat Med 2005;33:4653.
  22. Fertil Steril 2005;84:1285-99.
  23. How useful is 3D and 4D ultrasound in perinatal medicine. J Perinat Med 2007;35:10-27.
  24. The assessment of embryonic and fetal neurodevelopment in early pregnancy: comparison between 2D and 4D sonographic scanning. J Perinat Med 2005;33:406-14.
  25. Fetal behavior assessed in all three trimesters of normal pregnancy by four-dimensional ultrasonography. Croat Med J 2005;46:772-80.
  26. Normal and abnormal fetal hand positioning and movement in early pregnancy detected by three-and four-dimensional ultrasound. Ultrasound Rev Obset Gynecol 2004;4:46-51.
  27. Behavioral pattern continuity from prenatal to postnatal life-a study by four-dimensional (4D) ultrasonography. J Perinat Med 2004;32:346-53.
  28. Behavior of anencephalic fetus studied by 4D sonography. J Matern Fetal Neonatal Med 2005;17:165-8.
  29. The assessment of fetal behavior of growth restricted fetuses by 4D sonography. J Perinat Med 2006;34:471-8.
  30. Normal standards for fetal neurobehavioural developments-longitudinal quantification by four-dimensional sonography. J Perinat Med 2006;34:56-65.
  31. Three-and four-dimensional ultrasonography for the structural and functional evaluation of the fetal face. Am J Obstet Gynecol 2007;196:16-28.
  32. Fetal yawning assessed by 3D and 4D sonography. Ultrasound Rev Obstet Gynecol 2005;5:210-7.
  33. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol 2007;109 (suppl.):8-14.
  34. Strategies for the early diagnosis of cerebral palsy. J Pediatr 2004;145:S8-S11.
  35. Factors identified during the neonatal period associated with risk of cerebral palsy. Australian and New Zeland Journal of Obstetrics and Gynecology 2004;44:342-6.
  36. Neonatal signs as predictors of cerebral palsy. Pediatrics 1979;64:225-32.
  37. Neurosonography in the seconf half of fetal life: a neonatologist point of view. J Perinat Med 2006;34:437-46.
  38. The Amiel-Tison neurological assessment at term: conceptual and methodological continuity in the course of follow-up. Mental Retardation and Developmental Disabilities Research Reviews 2005;11:34-51.
  39. Update of the Amiel-Tison Neurological assessment for the term neonate or at 40 weeks corrected age. Pediatr Neurol 2002;27:196-212.
  40. Neurological examination: Normaland abnormal fetures. In Neurology of the newborn (4th edn). Philadelphia: WB Saunders, 2001:127.
  41. Prechtl's, ethod on the qualitative assessment of general movements in preterm, term and young infants. Mac Keith Press, Cambridge, 2004.
  42. General movements: a window for early identification of children at high risk for developmental disorders. J Pediatr 2004;145:S12-8.
  43. Assessment of general movements: towards a better understanding of a sensitive method to evaluate brain function in young infants. Dev Med Child Neurol 1997;39:89-99.
  44. Motor behaviour in the growth retarded fetus. Early Human Development 1985;12:155-65.
  45. Preterm and early postterm motor behaviour in low-risk premature infants. Early Hum Dev 1990;23:159-91.
  46. Predictive value of assessment of general movements for neurological development of high-risk preterm infants: comparative study. Croatian Medical Journal 2003;44:721-7.
  47. Which better predicts later outcome in full term infants: quality of general movements or neurological examination?. Early Hum Dev 1997;50:71-85.
  48. The qualitative assessment of general movements in preterm, term and young infants-review of the methodology. Early Hum Dev 1997;24:47-60.
  49. Cramped synchronized general movements in preterm infants as an early marker for cerebral palsy. Arch Pediatr Adolesc Med 2002;156:460-7.
  50. State of the art of a new functional assessment of the young nervous system. An early predictor of cerebral palsy. Early Hum Dev 1997;50:1-11.
  51. ) An atlas of Three-and Four-Dimensional Sonography in Obstetrics and Gynecology. Taylor & Francis Group: London, 2004.
  52. Anatomic and physiologic correlates of neurologic development in prematurity. In Sarnat HB (Ed): Topics in neonatal neurology. New York: Grune and Stratton, 1984;1-24.
  53. Functions of the corticospinal and corticobulbar tracts in the human newborns. J Pediatr Neurol 2003;1:3-8.
  54. Clinical assessment of the infant nervous system. In Levente MI, Chervenak FA and Whittle M (Eds): Fetal and Neonatal Neurology and Neurosurgery (3rd edn). Churchill Livingstone: London, 2001;99-120.
  55. Neurobehavioral Assessment from Fetus to Infant: the NICU Network Neurobehavioral Scale and the Fetal Neurobehavioral Coding System. MRDD Research Reviews 2005;11:14-20.
  56. Fetal motility in the first half of pregnancy. In: Prechtl HFR (ed.) Continuity of neural functions from prenatal to postnatal life. Clin Dev Med 94 Oxford, Blackwell, 1984;46-63.
  57. Early onset of synapse formation in the human hippocampus: a correlation with Nissl-Golgi architectonics in 15-and 16. 5-week-old fetuses. Neuroscience 1989;30:105-16.
  58. Cerebral palsy epidemiology: where are we now and where are we going? Dev Med Child Neurol 1992;34:547-51.
  59. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005;47:571-6.
  60. Cerebral palsy-definition, classification, etiology and early diagnosis. Indian J Pediatr 2005;72:865-8.
  61. Cerebral palsy: a reconceptualization of the spectrum. J Pediatr 2004;145(Suppl. 2):S3-7.
  62. Head growth and cranial assessment at neurological examination in infancy. Dev Med Child Neurol 2002;44:643-8.
  63. Clinical application of three-dimensional ultrasound in fetal brain assessment. Croat Med J 2000;41:245-51.
  64. Ultrasound antenatal diagnosis of cleft palate by a new technique: the 3D “reverse face” view. Ultrasound Obstet Gynecol 2005;25:12-8.
  65. Neurobehavioral assessment before birth. Mental Retardation and Developmental Disabilities Research Reviews 2005;11:4-13.
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