engleski

Neurological Evaluation of Growth-Restricted Fetuses

Intrauterine growth restriction (IUGR) and fetal hypoxia are risk factors for the development of the central nervous system (CNS) disorders. Fetal cardiovascular responses to hypoxia, which include the redistribution of the cardiac output towards the vital organs, are considered the most important adaptive reactions responsible for maintaining fetal homeostasis. The redistribution of blood flow towards the fetal brain is known as the brain-sparing effect. Our studies have demonstrated clearly that the brain- sparing effect cannot prevent the development of perinatal brain damage in the case of severe or prolonged hypoxia. Further, we have showed that hypoxia index, which takes into account cumulative oxygen deficit, could significantly improve the prediction of a poor neurological outcome in pregnancies complicated by IUGR and hypoxia. However, there is currently no direct method in the routine practice for assessment of the fetal CNS, although it is believed that fetal behavior reflects the brain development. After standardization of valid reference ranges of movements appropriate for the gestational age, a new scoring system for fetal behavior based on prenatal assessment by four dimensional (4D)sonography, KANET, was published. Further, we studied behavior of the severe growthrestricted fetuses using KANET and assessed its relationship with the hemodynamic parameters. In this case study abnormal fetal behavior correlated with pathologic hemodynamic parameters and with adverse postnatal outcome. However, not all fetuses with abnormal hemodynamic findings have pathological behavior. In recently published case report, we presented prenatal and postnatal neurological evaluation of the fetus and newborn from pregnancy complicated with IUGR, fetal hypoxemia, and preterm labor. Despite unfavorable intrauterine conditions, this infant showed normal early neurological development. Further studies involving a larger sample size are needed to ascertain the role of KANET and 4D ultrasound in the evaluation of neurological development of growth-restricted fetuses.

IUGR; hypoxia; fetal doppler; four dimensional ultrasound; brain development

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