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Intrauterine growth restriction and cerebral palsy.

Kurjak A, Predojevic M, Stanojevic M, Kadic AS, Miskovic B, Badreldeen A, Talic A, Zaputovic S, Honemeyer U - Acta Inform Med (2012)

Bottom Line: Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS.The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies.However, preliminary results are very encouraging.

View Article: PubMed Central - PubMed

Affiliation: Department Of Obstetrics and Gynecology, University Hospital "Sveti Duh", Medical School, University Of Zagreb, Zagreb, Croatia ; Feto Maternal Medicine Unit, Women'S Hospital, Hamad Medical Corporation, Doha, Qatar.

ABSTRACT
Intrauterine growth restriction (IUGR) can be described as condition in which fetus fails to reach his potential growth. It is common diagnosis in obstetrics, and carries an increased risk of perinatal mortality and morbidity. Moreover, IUGR has lifelong implications on health, especially on neurological outcome. There is a need for additional neurological assessment during monitoring of fetal well-being, in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Studies have revealed that the behavior of the fetus reflects the maturational processes of the central nervous system (CNS). Hence, ultrasound investigation of the fetal behavior can give us insight into the integrity and functioning of the fetal CNS. Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS. Based on previous observations and several years of investigation, our reaserch group has proposed a new scoring system for the assessment of fetal neurological status by 4D sonography named Kurjak antenatal neurodevelopmental test (KANET). The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies. However, preliminary results are very encouraging.

No MeSH data available.


Related in: MedlinePlus

3D surface rendering mode of the different fetal facial expressions in the third trimester. This ultrasound mode enables the investigation of behavioural fetal facial expression.
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Figure 2: 3D surface rendering mode of the different fetal facial expressions in the third trimester. This ultrasound mode enables the investigation of behavioural fetal facial expression.

Mentions: As early as possible, neonatologists try to identify neonates at risk of unfavourable neurodevelopmental outcomes. They are fairly reliable in predicting very poor outcomes as well as optimal outcomes. However, within these two extremes, the prediction still remains a challenge (22). Furthermore, there is a growing pool of evidence that many neurological disorders originate from intrauterine rather than perinatal or postnatal period. In addition, clinical and epidemiological studies have shown that even cerebral palsy (CP) most frequently results from prenatal rather than perinatal or postnatal causes (23). As the neuromotor system is the first to mature and cranial expansion passively follows hemispheric growth, neurological assessment should be able to produce early markers to predict later outcomes based on neuromotor and cranial findings. For many years, obstetricians have worked toward the same objective as neonatologists by monitoring fetal well-being during pregnancy. They rely on technical advances, namely ultrasonography (US) which has lead to the following statement: “Fetal behaviour can be defined as fetal activities observed or recorded with ultrasound equipment” (24). The advent of US has led to a kind of revolution. For more than 40 years, ultrasound has been extensively used in medical imaging, providing help for the diagnosis and staging of numerous diseases of different organs and systems of human body. The development of real time two-dimensional (2D) ultrasound has enabled the direct visualization of fetal anatomy and activity in utero. Analysis of the dynamics of fetal behaviour in comparison with morphological studies has led to the conclusion that fetal behavioural patterns directly reflect developmental and maturational processes of fetal central nervous system. Therefore, it was suggested that the assessment of fetal behavior and developmental processes in different periods of gestation may make possible the distinction between normal and abnormal brain development, as well as early diagnosis of various structural or functional abnormalities (25). However, 2D ultrasound was considered somewhat subjective method because information needs observer interpretation. The latest development of three-dimensional (3D) and four-dimensional (4D) sonography that overcame some of the limitations of 2D methods enable precise study of fetal and even embryonic activity and behavior. Contrary to the 3D ultrasound which freezes the image of an object and therefore does not provide information on movements, 4D enablesthe opportunity of simultaneous visualization of the movements of the head, body, and all four limbs and extremities in three dimensions, in a real-time mode. 4D ultrasound or real-time 3D ultrasound makes it straight forward to comprehend some morphological dynamics, such as yawning, sucking, smiling, crying and eye blinking. This offers a practical means for assessment of neurophysiologic development, as well as for detection of anatomical pathology (26, 27). New diagnostic tool additionally provides a possibility of spatial observation of fetal face, which was not provided by 2D sonography (28). 4D therefore allows the appearance and duration most of the each facial movement and expression to be determined and measured (Figure 1, 2).


Intrauterine growth restriction and cerebral palsy.

Kurjak A, Predojevic M, Stanojevic M, Kadic AS, Miskovic B, Badreldeen A, Talic A, Zaputovic S, Honemeyer U - Acta Inform Med (2012)

3D surface rendering mode of the different fetal facial expressions in the third trimester. This ultrasound mode enables the investigation of behavioural fetal facial expression.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232345&req=5

Figure 2: 3D surface rendering mode of the different fetal facial expressions in the third trimester. This ultrasound mode enables the investigation of behavioural fetal facial expression.
Mentions: As early as possible, neonatologists try to identify neonates at risk of unfavourable neurodevelopmental outcomes. They are fairly reliable in predicting very poor outcomes as well as optimal outcomes. However, within these two extremes, the prediction still remains a challenge (22). Furthermore, there is a growing pool of evidence that many neurological disorders originate from intrauterine rather than perinatal or postnatal period. In addition, clinical and epidemiological studies have shown that even cerebral palsy (CP) most frequently results from prenatal rather than perinatal or postnatal causes (23). As the neuromotor system is the first to mature and cranial expansion passively follows hemispheric growth, neurological assessment should be able to produce early markers to predict later outcomes based on neuromotor and cranial findings. For many years, obstetricians have worked toward the same objective as neonatologists by monitoring fetal well-being during pregnancy. They rely on technical advances, namely ultrasonography (US) which has lead to the following statement: “Fetal behaviour can be defined as fetal activities observed or recorded with ultrasound equipment” (24). The advent of US has led to a kind of revolution. For more than 40 years, ultrasound has been extensively used in medical imaging, providing help for the diagnosis and staging of numerous diseases of different organs and systems of human body. The development of real time two-dimensional (2D) ultrasound has enabled the direct visualization of fetal anatomy and activity in utero. Analysis of the dynamics of fetal behaviour in comparison with morphological studies has led to the conclusion that fetal behavioural patterns directly reflect developmental and maturational processes of fetal central nervous system. Therefore, it was suggested that the assessment of fetal behavior and developmental processes in different periods of gestation may make possible the distinction between normal and abnormal brain development, as well as early diagnosis of various structural or functional abnormalities (25). However, 2D ultrasound was considered somewhat subjective method because information needs observer interpretation. The latest development of three-dimensional (3D) and four-dimensional (4D) sonography that overcame some of the limitations of 2D methods enable precise study of fetal and even embryonic activity and behavior. Contrary to the 3D ultrasound which freezes the image of an object and therefore does not provide information on movements, 4D enablesthe opportunity of simultaneous visualization of the movements of the head, body, and all four limbs and extremities in three dimensions, in a real-time mode. 4D ultrasound or real-time 3D ultrasound makes it straight forward to comprehend some morphological dynamics, such as yawning, sucking, smiling, crying and eye blinking. This offers a practical means for assessment of neurophysiologic development, as well as for detection of anatomical pathology (26, 27). New diagnostic tool additionally provides a possibility of spatial observation of fetal face, which was not provided by 2D sonography (28). 4D therefore allows the appearance and duration most of the each facial movement and expression to be determined and measured (Figure 1, 2).

Bottom Line: Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS.The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies.However, preliminary results are very encouraging.

View Article: PubMed Central - PubMed

Affiliation: Department Of Obstetrics and Gynecology, University Hospital "Sveti Duh", Medical School, University Of Zagreb, Zagreb, Croatia ; Feto Maternal Medicine Unit, Women'S Hospital, Hamad Medical Corporation, Doha, Qatar.

ABSTRACT
Intrauterine growth restriction (IUGR) can be described as condition in which fetus fails to reach his potential growth. It is common diagnosis in obstetrics, and carries an increased risk of perinatal mortality and morbidity. Moreover, IUGR has lifelong implications on health, especially on neurological outcome. There is a need for additional neurological assessment during monitoring of fetal well-being, in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Studies have revealed that the behavior of the fetus reflects the maturational processes of the central nervous system (CNS). Hence, ultrasound investigation of the fetal behavior can give us insight into the integrity and functioning of the fetal CNS. Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS. Based on previous observations and several years of investigation, our reaserch group has proposed a new scoring system for the assessment of fetal neurological status by 4D sonography named Kurjak antenatal neurodevelopmental test (KANET). The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies. However, preliminary results are very encouraging.

No MeSH data available.


Related in: MedlinePlus