Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 5 , ISSUE 4 ( October-December, 2011 ) > List of Articles

EDITORIAL

An Attempt to Standardize Kurjak's Antenatal Neurodevelopmental Test: Osaka Consensus Statement

Maja Predojevic, Berivoj Miskovic, Badreldeen Ahmed, Radu Vladareanu, Aida Salihagic Kadic, Afaf Naim Shaddad, Madeeha Al-Noobi, Amira Talic, Milan Stanojevic, Daniela Lebit, Salwa Abu-Yaqoub

Keywords : 4D ultrasound,Cerebral palsy,Fetal neurobehavior,Neurobehavioral screening,Postnatal neurological screening

Citation Information : Predojevic M, Miskovic B, Ahmed B, Vladareanu R, Kadic AS, Shaddad AN, Al-Noobi M, Talic A, Stanojevic M, Lebit D, Abu-Yaqoub S. An Attempt to Standardize Kurjak's Antenatal Neurodevelopmental Test: Osaka Consensus Statement. Donald School J Ultrasound Obstet Gynecol 2011; 5 (4):317-329.

DOI: 10.5005/jp-journals-10009-1209

License: CC BY-NC 4.0

Published Online: 00-12-2011

Copyright Statement:  Copyright © 2011; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Analysis of the dynamics of fetal behavior in comparison with morphological studies has led to the conclusion that fetal behavioral patterns are directly reflecting developmental and maturational processes of fetal central nervous system (CNS). Four-dimensional ultrasound (4D US) offers a practical means for assessment of both the brain function and structure. The visualization of fetal activity in utero by 4D US could allow distinction between normal and abnormal behavioral patterns which might make possible the early recognition of fetal brain impairment. That new technology enabled introduction of Kurjak's antenatal neurodevelopmental test (KANET) in low- and high-risk pregnancies. In order to make the test reproducible, the standardization of the test was proposed in Osaka, Japan, during the International Symposium on Fetal Neurology of International Academy of Perinatal Medicine.

The KANET should be performed in the 3rd trimester from 28th to 38th week of gestation. The assessment should last from 15 to 20 minutes, and the fetuses should be examined when awake. If the fetus is sleeping, the assessment should be postponed for 30 minutes or for the next day between 14 and 16 hours. In cases of definitely abnormal or borderline score, the test should be repeated every two weeks till delivery. New modified KANET test should be used with eight instead of 10 parameters: Facial and mouth movements are combined in one category, isolated hand movements and hand to face movements are combined in one category. The score should be the same for abnormal fetuses 0 to 5, borderline score is from 6 to 13 and normal score is 14 or above.

After 4D US assessment of behavioral patterns in the fetuses from high-risk pregnancies, it is very important to continue with follow-up after delivery in infants who were borderline or abnormal as fetuses. Postnatal assessment of neonates includes initial neurological assessment according to Amiel-Tison's methodology (Amiel-Tison Neurological Assessment at Term, ATNAT) in the early neonatal period and every two weeks in preterm infants till discharge and at the postmenstrual age (PMA) between 37 and 40 weeks. If ATNAT is borderline or abnormal, initial assessment of general movements at the age of 36 to 38 weeks of PMA should be performed, than at writhing age (between 46 and 52 weeks), and at the fidgety age after 54 weeks of PMA. If the finding of fidgety movements is mildly abnormal or definitely abnormal, then one more assessment should be done in 2 to 4 weeks till PMA of 58 weeks. Brain ultrasonography should be performed in the first week of life and every 2 weeks afterward till discharge. In severely affected infants with grade 3 and above intraventricular hemorrhage, and those highly suspicious of hypoxic ischemic brain damage, magnetic resonance (MR) should be done if available. Infants should be followed until the age of at least 24 months when diagnosis of disabling or nondisabling cerebral palsy can be ultimately made. Infants with CP should be reassessed at the age of 6 years.


PDF Share
  1. Normal fetal motility: An overview. Ultrasound Obstet Gynecol 2006;27:701-11.
  2. Fetal general movements and brain sonography in a population at risk for preterm birth. Early Hum Dev 2010;86:107-11.
  3. Changes in fetal motility as a result of congenital disorders: An overview. Ultrasound Obstet Gynecol 2007;29:590-99.
  4. Qualitative changes of spontaneous movements in fetus and preterm infant are a marker of neurological dysfunction. Early Hum Dev 1990;23:151-58.
  5. Prenatal diagnosis: What does four-dimensional ultrasound add? J Perinat Med 2002;30:57-62.
  6. The antenatal development of fetal behavioral patterns assessed by four-dimensional sonography. J Matern Fetal Neonatal Med 2005;17:401-16.
  7. New scoring system for fetal neurobehavior assessed by three-and four-dimensional sonography. J Perinat Med 2008;36:73-81.
  8. Fetal onset of general movements. Pediatr Res 2008;63: 191-95.
  9. Quantitative studies on fetal actocardiogram. Croat Med J 2005;46:792-96.
  10. Is neurological assessment of the fetus possible? Eur J Obstet Gynecol 1997;75:81-84.
  11. Fetal behaviour: Developmental and perinatal aspects. Oxford: Oxford University Press 1992.
  12. The emergence of fetal behavior (I). Qualitative aspect. Early Hum Dev 1982;7: 301-22.
  13. The emergence of fetal behaviour (II). Quantitative aspects. Early Hum Dev 1985;12: 99-120.
  14. Outcome after intrapartum hypoxic ischaemia at term. Semin Fetal Neonatal Med 2007;12:398-407.
  15. Diagnosis, treatment, and prevention of cerebral palsy. Clin Obstet Gynecol 2008;51:816-28.
  16. Defining cerebral palsy: Pathogenesis, pathophysiology and new intervention. Minerva Ginecol 2009;61:421-29.
  17. Prechtl's method on the qualitative assessment of general movements in preterm, term, and young infants. London: Mac Keith Press 2004.
  18. Fetal behavioral teratology. J Matern Fetal Neonatal Med 2010;23(Suppl 3):14-16.
  19. Fetal response to induced maternal emotions. J Physiol Sci 2010;60:213-20.
  20. Incidence of fetal akinesia-hypokinesia deformation sequence: A population-based study. Acta Paediatr 2009;98:3-4.
  21. Neurosonography in the second half of fetal life: A neonatologist's point of view. J Perinat Med 2006;34:437-46.
  22. Assessment of fetal behavior and general movements by four-dimensional sonography. Ultrasound Rev Obstet Gynecol 2004;4:103-14.
  23. Four-dimensional sonography in the assessment of fetal functional neurodevelopment and behavioral patterns. Ultrasound Rev Obstet Gynecol 2005;5:154-68.
  24. Three-dimensional and fourdimensional sonography in the study of the fetal face. Ultrasound Rev Obstet Gynecol 2003;3:1-10.
  25. Fetal behavior assessed in all three trimesters of normal pregnancy by four-dimensional ultrasonography. Croat Med J 2005;46:772-80.
  26. Simplified ultrasound screening for fetal brain function based on behavioral pattern. Early Hum Dev 2007;83:177-81.
  27. Fetal behavioral and structural abnormalities in high-risk fetuses assessed by 4D sonography. The Ultrasound Review of Obstetrics and Gynecology 2005;5:1-13.
  28. Behavioral pattern continuity from prenatal to postnatal life–a study by four-dimensional (4D) ultrasonography. J Perinat Med 2004;32:346-53.
  29. What does fetal movement predict about behavior during the first two years of life? Dev Psychobiol 2002;40:358-71.
  30. The onset of interhuman contacts. Longitudinal ultrasound observations in twin pregnancies. Ultrasound Obstet Gynecol 1996;8:166-73.
  31. Fetal state concordance predicts infant state regulation. Early Hum Dev 2002;68:1-13.
  32. Predictive value of definitely abnormal general movements in the general population. Dev Med Child Neurol 2010;52:456-61.
  33. Chorioamnionitis and cerebral palsy: A metaanalysis. Obstet Gynecol 2010;116(2 Pt 1):387-92.
  34. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005;47:571-76.
  35. A report: The definition and classification of cerebral palsy. Dev Med Child Neurol 2007;109:8-14.
  36. Strategies for the early diagnosis of cerebral palsy. J Pediatr 2004;145:S8-11.
  37. Definition and classification of cerebral palsy: A historical perspective. Dev Med Child Neurol 2007493-7. DOI: 10.1111/j.1469-8749.2007.tb12609.x (accessed Dec 12, 2010).
  38. Recommendations from the SCPE collaborative group for defining and classifying cerebral palsy. Dev Med Child Neurol 20074935-38. DOI: 10.1111/j.1469-8749.2007.tb12626.x (accessed Dec 12, 2010).
  39. Epidemiology of the cerebral palsies. Orthop Clin North Am 2010;41:441-55.
  40. SCPE work, standardization and definition: An overview of the activities of SCPE: A collaboration of European CP registers. Zhongguo Dang Dai Er Ke Za Zhi 2006;8:261-65.
  41. The changing panorama of cerebral palsy in Sweden (X). Prevalence and origin in the birth-year period 1999-2002. Acta Paediatr 2010;99: 1337-43.
  42. Children with cerebral palsy: Severity and trends over time. Paediatr Perinat Epidemiol 2009;23:513-21.
  43. 4D or not 4D: That is the question. Ultrasound Obstet Gynecol 2002;19:1-4.
  44. Fetal hand movements and facial expression in normal pregnancy studied by four-dimensional sonography. J Perinat Med 2003;31:496-508.
  45. The potential of four-dimensional (4D) ultrasonography in the assessment of fetal awareness. J Perinat Med 2005;33:46-53.
  46. Basic consciousness of the newborn. Semin Perinatol 2010;34:201-06.
  47. A womb with a view: Ultrasound for evaluation of fetal neurobehavioral development. Infant and Child Development 2010;19:119-24.
  48. How useful is 3D and 4D ultrasound in perinatal medicine? J Perinat Med 2007;3:10-27.
  49. Normal standards of fetal behavior assessed by four-dimensional sonography. J Matern Fetal Neonatal Med 2006;19:707-21.
  50. Normal standards for fetal neurobehavioral developments–longitudinal quantification by four-dimensional sonography. J Perinat Med 2006;34:56-65.
  51. Realtime 3D sonographic observation of fetal facial expression. J Obstet Gynaecol Res 2005;3:337-40.
  52. Ultrasound for evaluation of fetal neurobehavioural development: From 2D to 4D ultrasound. Inf Child Dev 2010;19: 99-118.
  53. Four-dimensional sonographic assessment of fetal movement in the late first trimester. Int J Gynaecol Obstet 2010;109:190-93.
  54. Four-dimensional sonographic assessment of inter-twin contact late in the first trimester. Int J Gynaecol Obstet 2010;108:104-07.
  55. Neurological assessment of the neonate revisited: A personal view. Dev Med Child Neurol 1990;32: 1109-13.
  56. Why is the neurological examination so badly neglected in early childhood? Pediatrics 2005;116:1047.
  57. The Amiel-Tison neurological assessment at term: Conceptual and methodological continuity in the course of follow-up. Ment Retard Dev Disabil Res Rev 2005;11:34-51.
  58. Interexaminer reliability of Amiel-Tison neurological assessments. Pediatr Neurol 2009;41:347-52.
  59. Variation and variability: Keywords in human motor development. Phys Ther 2010;90:1823-37.
  60. Putative neural substrate of normal and abnormal general movements. Neurosci Biobehav Rev 2007;31:1181-90.
  61. The assessment of fetal neurobehavior by three-dimensional and four-dimensional ultrasound. J Matern Fetal Neonatal Med 2008;21:675-84.
  62. The comparison of fetal behavior in high risk and normal pregnancies assessed by four-dimensional ultrasound. J Matern Fetal Neonatal Med 2010;23:1461-67.
  63. The assessment of fetal behavior of growth restricted fetuses by 4D sonography. J Perinat Med 2006;34:471-78.
  64. The potential of 4D sonography in the assessment of fetal neurobehavior–multicentric study in high-risk pregnancies. J Perinat Med 2010;38:77-82.
  65. The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies. J Matern Fetal Neonatal Med 2010 (in press).
  66. Cerebral palsy and the application of the international criteria for acute intrapartum hypoxia. Obstet Gynecol 2006;107: 1357-65.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.