Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 5 , ISSUE 2 ( April-June, 2011 ) > List of Articles


Continuity from Fetal to Neonatal Behavior: Lessons Learned and Future Challenges

Keywords : Development of central nervous system,Fetal neurobehavior,Four-dimensional ultrasound,General movements,Neonatal neurobehavior

Citation Information : Continuity from Fetal to Neonatal Behavior: Lessons Learned and Future Challenges. Donald School J Ultrasound Obstet Gynecol 2011; 5 (2):107-118.

DOI: 10.5005/jp-journals-10009-1185

License: CC BY-NC 4.0

Published Online: 01-12-2011

Copyright Statement:  Copyright © 2011; The Author(s).


Understanding the relation between fetal and infant behavior and developmental processes of the brain in different periods of gestation may make achievable the distinction between normal and abnormal brain development as well as the early diagnosis of various structural or functional abnormalities. As the development of the brain is unique and continuing process throughout the gestation and after birth, it is expected that there is also continuity of fetal and neonatal behavior, which is the best functional indicator of developmental processes of the brain.

The aim is to present continuity of the general and other movements from prenatal to postnatal life in fetuses and newborns from low- and high-risk pregnancies.

Epidemiological studies revealed that many neurologically impaired infants belong to low-risk population, which means that they seemed to be developmentally normal as fetuses and as infants, while later in childhood neurological disability was diagnosed. Dyskinetic cerebral palsy (CP) is the dominant type of CP found in term-born, appropriate-for-gestational-age children with severe impairments who have frequently experienced adverse perinatal events. As neuroprotective methods of treatment are available for some infants, simple screening methods could be helpful to detect impaired fetuses early enough in order to avoid developmental catastrophe. It has been clear from postnatal assessment of Prechtl's neonatal general movements (GMs) that it is a better predictor of neurodevelopmental disability than neurological examination. Introduction of two-dimensional (2D) and four-dimensional (4D) ultrasound enabled introduction of GMs assessment to the prenatal period. Kurjak et al conducted a study by 4D ultrasound and confirmed earlier findings made by 2D ultrasonography, that there is behavioral pattern continuity from prenatal to postnatal life. New antenatal neurological screening test has been introduced by Kurjak et al (KANET), which was postnatally followed by postnatal neurological screening assessment according to Amiel-Tison (ATNAT). Although many fetal behavioral studies have been conducted in low- and high-risk pregnancies and KANET has been recently standardized, it is still questionable whether the assessment of continuity from fetal to neonatal behavior could improve ability for early detection of brain pathology.

PDF Share
  1. Determination and differentiation in the development of the nervous system. In: Kandel ER, Schwartz JH. Principles of neural science (2nd ed). New York-Amsterdam-Oxford: Elsevier Science Publishing 1985:730-32.
  2. Prenatal development of nucleus basalis complex and related fibre system in man: A hystochemical study. Neuroscience 1986;17:1047-77.
  3. Zentralnervensystem. In: Hinrichsen KV (Ed). Humanembryologie. Berlin: Springer-Verlag 1990:381-448.
  4. A growth chart for premature and other infants. Arch Dis Child 1971;46:783-87.
  5. The living fetus–dilemmas in treatment at the edge of viability. In: Blazer S, Zimmer EZ (Eds). The embryo: Scientific discovery and medical ethics. Basel, Karger 2005:351-70.
  6. The human brain in numbers: A linearly scaled-up primate brain. Frontiers in Human Neuroscience 2009;3:1-11.
  7. A universal scaling law between gray matter and white matter of cerebral cortex. PNAS 2000;97: 5621-26.
  8. Abnormal cortical development after premature birth shown by altered allometric scaling of brain growth. PLoS Med 2006;3:1382-90.
  9. Fetal behavioral and structural abnormalities in high risk fetuses assessed by 4D sonography. Ultrasound Rev Obstet Gynecol 2005;5:275-87.
  10. Dyskinetic cerebral palsy: A population-based study of children born between 1991 and 1998. Dev Med Child Neurol 2007;49:246-51.
  11. Determinants of outcomes after head cooling for neonatal encephalopathy. Pediatrics 2007;119:912-21.
  12. Early developmental intervention programs post hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev 2007;(2):CD005495.
  13. High familial risks for cerebral palsy implicate partial heritable aetiology. Paediatr Perinat Epidemiol 2007;21:235-41.
  14. The assessment and significance of habituation to a repeated stimulus by the human fetus. Early Hum Dev 1982;7(3):211-19.
  15. Cerebral lateralization: Biological mechanisms, associations and pathology. Arch Neurol 1985;42:428-59.
  16. Sex and the pathogenesis of cerebral palsy. Dev Med Child Neurol 2007;49:74-78.
  17. Male sex and intraventricular hemorrhage. Pediatr Crit Care Med 2006;7:40-44.
  18. Cerebral palsy and intrauterine growth. Clin Perinatol 2006;33:285-300.
  19. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005;352:9-19.
  20. A report: The definition and classification of cerebral palsy April 2006. Dev Med Child Neurol 2007;109(suppl.):8-14.
  21. Strategies for the early diagnosis of cerebral palsy. J Pediatr 2004;145:S8-11.
  22. Factors identified during the neonatal period associated with risk of cerebral palsy. Aust N Z J Obstet Gynecol 2004;44:342-46.
  23. Fetal sensory receptors. Physiol Rev 1975;55:352-82.
  24. Some pathological, radiological and clinical implications of the precocious development of the human ear. Laryngoscope 1964;74:1160-71.
  25. The fetus cannot exercise like an astronaut: Gravity loading is necessary for the physiological development during second half of pregnancy. Med Hypotheses 2005;64:221-28.
  26. Relationship between antigravity control and postural control in young children. Phys Ther 1988;68:486-90.
  27. Development of postural control in healthy children: A functional approach. Neural Plast 2005;12:109-18.
  28. The changing panorama of cerebral palsy in Sweden (IX). Prevalence and origin in the birth-year period 1995-1998. Acta Paediatr 2005;94:287-94.
  29. Cerebral palsy in a term population: Risk factors and neuroimaging findings. Pediatrics 2006;118;690-97.
  30. Neonatal signs as predictors of cerebral palsy. Pediatrics 1979;64:225-32.
  31. Neurosonography in the second half of fetal life: A neonatologist point of view. J Perinat Med 2006;34:437-46.
  32. How useful is 3D and 4D in perinatal medicine? J Perinat Med 2007;35:10-27.
  33. The assessment of fetal neurobehavior by three-dimensional and four-dimensional ultrasound. J Matern Fetal Neonatal Med 2008;21:675-84.
  34. Further experience in the clinical assessment of fetal neurobehavior. Donald School Journal of Ultrasound in Obstetrics and Gynecology 2010;4:59-71.
  35. The role of perinatal and intrapartum risk factors in the etiology of cerebral palsy in term deliveries in a Turkish population. J Matern Fetal Neonatal Med 2006;19:147-55.
  36. 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.
  37. Update of the Amiel-Tison neurological assessment for the term neonate or at 40 weeks corrected age. Pediatr Neurol 2002;27:196-212.
  38. Neurological examination: Normal and abnormal fetuses. In. Neurology of the newborn (4th ed). Philadelphia: WB Saunders 2001:127.
  39. Predictive value of neurodevelopmental assessment versus evaluation of general movements for motor outcome in preterm infants with birth weights < 1500 gm. Neuropediatrics 2007;38:91-99.
  40. Prechtl's method on the qualitative assessment of general movements in preterm, term and young infants. Mac Keith Press, Cambridge 2004.
  41. General movements: A window for early identification of children at high risk for developmental disorders. J Pediatr 2004;145:S12-18.
  42. Qualitative changes of spontaneous movements in fetus and preterm infant are a marker of neurological dysfunction. Early Hum Dev 1990;23:151-58.
  43. The relative roles of feedforward and feedback in the control of rhythmic movements. Motor Control 2002;6:129-45.
  44. The emergence of fetal behavior. Qualitative aspects. Early Hum Dev 1982;7:301-22.
  45. 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.
  46. Motor behaviour in the growth retarded fetus. Early Human Development 1985;12:155-65.9.
  47. Preterm and early post-term motor behaviour in low-risk premature infants. Early Hum Dev 1990;23:159-91.
  48. Predictive value of assessment of general movements for neurological development of high-risk preterm infants: Comparative study. Croatian Medical Journal 2003;44:721-27.
  49. Which better predicts later outcome in full term infants: Quality of general movements or neurological examination? Early Hum Dev 1997;50:71-85.
  50. Movement analysis in neonates with spina bifida aperta. Early Hum Dev 2006;82:227-34.
  51. The general movements in children with Down syndrome. Early Hum Dev 2004;79: 119-30.
  52. Neonatal general movements: An early predictor for neurodevelopmental outcome in infants with intrauterine growth retardation. J Child Neurol 2004;19:14-18.
  53. Psychomotor development and general movements in offspring of women with epilepsy and anticonvulsant therapy. Early Hum Dev 2003;74:97-108.
  54. Fetal hand and facial expression in normal pregnancy studied by four-dimensional sonography. J Perinat Med 2003;31:496-508.
  55. The fetus in three dimensions. Imaging, embryology and fetoscopy. Informa Healthcare, London 2007.
  56. Behavioral pattern continuity from prenatal to postnatal life: A study by four-dimensional (4D) ultrasonography. J Perinat Med 2004;32:346-53.
  57. From fetal to neonatal behavioral status. Ultrasound Rev Obstet Gynecol 2004;4:459-71.
  58. The potential of four-dimensional ultrasonography in the assessment of fetal awareness. J Perinat Med 2005;33:46-53.
  59. 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.
  60. Functions of the corticospinal and corticobulbar tracts in the human newborns. J Pediatr Neurol 2003;1:3-8.
  61. Clinical assessment of the infant nervous system. In: Levene MI, Chervenak FA, Whittle M (Eds) Fetal and Neonatal Neurology and Neurosurgery (3rd ed). Churchill Livingstone: London 2001:99-120.
  62. Neurobehavioral assessment from fetus to infant: The NICU network neurobehavioral scale and the fetal neurobehavioral coding system. MRDD Research Reviews 2005;11:14-20.
  63. 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.
  64. Ontogenesis of goaldirected behavior: Anatomo-functional considerations. International Journal of Psychophysiology 1995;19:85-102.
  65. 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.
  66. Cerebral palsy epidemiology: Where are we now and where are we going? Dev Med Child Neurol 1992;34:547-51.
  67. Executive committee for the definition of cerebral palsy. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005;47:571-76.
  68. Cerebral palsy: Definition, classification, etiology and early diagnosis. Indian J Pediatr 2005;72:865-68.
  69. Cerebral palsy: A reconceptualization of the spectrum. J Pediatr 2004;145(Suppl. 2):S3-7.
  70. Head growth and cranial assessment at neurological examination in infancy. Dev Med Child Neurol 2002;44:643-48.
  71. Clinical application of three-dimensional ultrasound in fetal brain assessment. Croat Med J 2000;41:245-51.
  72. Ultrasound antenatal diagnosis of cleft palate by a new technique: The 3D “reverse face” view. Ultrasound Obstet Gynecol 2005;25:12-18.
  73. Normal and abnormal fetal hand positioning and movement in early pregnancy detected by three-and fourdimensional ultrasound. Ultrasound Rev Obstet Gynecol 2004;4:46-51.
  74. The potential of 4D sonography in the assessment of fetal neurobehavior: Multicentric study in highrisk pregnancies. J Perinat Med 2010;38:77-82.
  75. New scoring system for fetal neurobehavior assessed by three-and four-dimensional sonography. J Perinat Med 2008;36:73-81.
  76. The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies. J Matern Fetal Neonatal Med 2010 (in press)(DOI: 10.3109/14767058.2010.534830.
  77. Od fetalne do neonatalne neurologije. Gynaecol Perinatol 2010;19:16-24.
  78. Neurobehavioral assessment before birth. Mental Retardation and Developmental Disabilities Research Reviews 2005;11:4-13.
  79. An attempt to standardize Kurjak's antenatal neurodevelopmental test (KANET)–Osaka consensus statement. Donald School Journal of Ultrasound in Obstetrics and Gynecology 2011 (submitted for publication).
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.