Can brain impairment be detected by in utero behavioural patterns?

Abstract

Fetal behavioural patterns were examined to test whether they could be used to localise sites of brain damage antenatally. Decreased fetal movement, persistent nonreactive fetal heart rate (FHR) pattern, and/or central nervous system malformation were used as indicators of possible neurological impairment. Ten fetuses tested in this way underwent further ultrasound examination observing movement of the extremities, chest wail (breathing), and eye and mouth, and active/quiet FHR paterns. Eight of these 10 fetuses were found on postnatal examination to have a brain impairment. The fetuses having potential in utero brain impairment were divided into four groups: those with (1) lesion sites at, or caudal to, the ponsmedulla that were specifically identified by fetal behaviour, (2) diffuse lesions in the brain which, although resulting in abnormal behaviour, could not be localised by this behaviour, (3) lesions localised in the cerebral hemisphere(s) but with no abnormal behaviour, and (4) temporally abnormal behaviour in utero, finally ch g over to a normal pattern with no neonatal neurological abnormality. A screening system for the antenatal assessment of brain impairment is thus proposed.

Choroid plexus cysts do not affect fetal neurodevelopment

“…Neurobehavioral development includes those parameters that have a strong maturational component and are presumed to reflect the development of the underlying neurosubstrate. Measurement of these subtle aspects of functioning, including how fetuses move, the nature and magnitude of fluctuations in heart rate patterns and the linkage between motor and cardiac activity, has served to detect differences in development between fetuses affected by a variety of conditions, including congenital malformations, 12 growth restriction, 13 maternal diabetes 14 and substance exposure. 15 Further consensus that fetal neurobehaviors provide opportunities to assess indirectly the nervous system, with implications for development after birth, has come from numerous sources focused on normally developing fetuses.…”

Computerised Analysis of Fetal Behaviour

“…Conventional behavioural analysis has revealed useful information about the development of the human fetus in both normal and abnormal pregnancies [1,2,[4][5][6][7][8], How ever, it is time-consuming and laborious [3]. Recording fetal behaviour requires continuous ultrasonic observa There is no doubt that the method we have described in this paper overcomes many of these drawbacks.…”

“…In principle, this method of Doppler recording of fetal behaviour and computerised analysis holds promise for screening and diagnosis in clinical practice which would complement existing methods [4]. If shown to be of value in the recording of unstiniulated behaviour, it could be adapted to study stimulated fetal behaviour [5] and ha bituation [6], However, the method has limitations.…”

“…Behavioural states in the term fetus were first de scribed in 1982 [1], A range of pathologies can disrupt normal neurobehavioural development and can be de tected with ultrasound [2,3], and screening for fetuses with functional central nervous system abnormalities has already been proposed [4], However, conventional fetal behavioural analysis used in such studies is laborious and time-consuming and if it is to have a role in the routine clinical setting for screening and/or diagnosis, then practi cal and more objective methods are necessary. We de scribe a computerised fetal behavioural analysis pro gramme, compare it with conventional methods of behav ioural analysis and demonstrate its limitations.…”

Fetal Behavior in High-risk Pregnancies Assessed by Two-Dimensional (2D) and Three-Dimensional/Four-Dimensional (3D)/(4D) Ultrasound: A Review

“…In the recent study from Morokuma the effort has been made to produce screening test that would be less time consuming and in that way cost effective as compared to their previous study. 52 They devised a brief ultrasound examination to distinguish fetuses with compromised central nervous system function from the general population and evaluated it within their study. 53 The study design compared findings on five behavioral patterns obtained by retrospectively reviewing the ultrasound examinations of 5 fetuses who had abnormal behavior with prospectively obtained findings of 29 normal fetuses.…”