Kurjak's Antenatal Neurodevelopmental Test Score Research Articles

Doppler ultrasonography of the uterine artery in correlation with KANET

The aim of this prospective study was to correlate the Doppler ultrasonography of the uterine arteries with the Kurjak Antenatal Neurodevelopmental Test (KANET), to investigate the effect of uterine artery flow assessed by the Doppler on fetal behavior. A population of 80 pregnant women in the second trimester of pregnancy was included for uterine artery Doppler (UAD) assessment. The investigation group consisted of 40 women with abnormal UAD, while the control group consisted of 40 women with normal UAD. The inclusion criteria for the investigated group were: gestation above 20weeks, and an abnormal finding of Doppler ultrasonography of the uterine arteries. All patients underwent a KANET test and were followed up to the end of their pregnancy. There was a statistically significant difference in the average score of KANET tests between the two groups (9.20±3.32 vs. 13.55±2.21; p=0.001). In the first group, an abnormal flow on the side of the placenta affected the score of the KANET test (B=11.948; p=0.005), while abnormal flow on the opposite side did not affect the score of the KANET test (p>0.05). Physiological flow had no effect on the KANET test in the control group (p>0.05). Abnormal flow affects the value of the KANET score, and can be used as one of the parameters inevaluation of probable fetal neurodevelopmental disorders.

Effect of psychotropic drugs on fetal behavior in the third trimester of pregnancy.

To assess the effect of psychotropic drugs on fetal behavior using four-dimensional (4D) ultrasound in the third trimester of pregnancy. Fetal behavior was assessed using Kurjak's antenatal neurodevelopmental test (KANET) using 4D ultrasound between 28 and 36 weeks of gestation. Thirty healthy (control group) and 10 psychotropic-drug-administered pregnant (case group) women were studied. The total value of the KANET score and values of each parameter (eight parameters) were compared between the two groups. The total KANET score was normal (except for one fetus in the case group: total score of 9) in both groups, and there was no significant difference in the total KANET score. When individual KANET parameters were compared, no significant differences were noted in any of the eight parameters. Our results showed that there is no difference in fetal behavior between fetuses of normal pregnant women and those of psychotropic-drug-administered pregnant women in the third trimester of pregnancy. These results suggest that psychotropic drugs may not affect fetal behavioral development in utero. However, the data and their interpretation in the present study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size are needed to assess the effect of psychotropic drugs on fetal neurobehavior during pregnancy.

Does Parity have an Effect on Fetal Behavior? A Comparison between Primi- and Multiparas

ABSTRACT Aim To evaluate the effect of parity on fetal behavior between primi- and multiparas. Materials and methods Fetal behavior was assesed by Kurjak's antenatal neurodevelopmental test (KANET) using four-dimensional (4D) ultrasound between 32 and 36 weeks of gestation. Forty-four primiparous and 61 multiparous women were studied. The total value of the KANET score and values of each parameter (8 parameters) were compared Results The total KANET score was normal in both groups except for in only one case in the multiparous group (total KANET score of 9), and there was no significant difference in the total KANET score. When individual KANET parameters were compared, we found a significant difference in only one fetal movement, isolated eye blinking, between fetuses of primiparas (median, 2; range, 0–2) and multiparas (median, 1; range, 0–2) (p < 0.040). No significant differences were noted in the other seven parameters. Conclusion Our results suggest that the level of relaxation of pregnant women may affect fetal behavior, particularly the rate of eye blinking. A relaxed state of primiparas may promote the maturation of the fetal brain, especially the central dopamine system function How to cite this article Hata T, Hanaoka U, AboEllail MAM, Uematsu R, Noguchi J, Kusaka T, Kurjak A. Does Parity have an Effect on Fetal Behavior? A Comparison between Primiand Multiparas. Donald School J Ultrasound Obstet Gynecol 2016;10(1):99-102.

Is Kurjak Antenatal Neurodevelopmental Test Ready for Routine Clinical Application? Bucharest Consensus Statement

ABSTRACTBackgroundWhile two-dimensional ultrasound (2D US) is used only for the assessment of fetal startles and general movements, introduction of Kurjak antenatal neurodevelopmental test (KANET) by four-dimensional ultrasound (4D US) enabled assessment of not only movements but also some signs used in postnatal neurological assessment like cranial sutures, head circumference and finger movements of the hand for the detection of neurological thumb (adducted thumb in the clenched feast). Overall impression on general movement called by Prechtl ‘Gestalt perception’ is also a part of KANET assessment. These parameters cannot be assessed by 2D US, and according to our opinion they are making the difference enabling more accurate and functionally more reliable assessment of the young and immature CNS.After Osaka standardization of KANET has been published, many studies on fetal behavior from different centers using this method have been conducted and published. Although there is lack of long-term follow-up of children who were assessed by KANET as fetuses, some conclusions on the usage of KANET test in clinical practice can be made. There are still inconclusive results of prenatal neurological assessment using KANET test in fetuses with borderline scores, although it was revealed that negative predictive value of the test as well as inter-observer reliability were satisfactory and acceptable.ConclusionIt can be concluded that KANET test can be used in everyday clinical practice for the follow-up of fetuses at neurological risk with the strong recommendation for strict and reliable multidisciplinary postnatal follow-up till the corrected age of at least 3 years and longer whenever appropriate. This will enable to make better correlation of prenatal KANET scores with postnatal neurodevelopmental outcomes.How to cite this articleStanojevic M, Antsaklis P, Kadic AS, Predojevic M, Vladareanu R, Vladareanu S, Neto RM. Is Kurjak Antenatal Neurodevelopmental Test Ready for Routine Clinical Application? Bucharest Consensus Statement. Donald School J Ultrasound Obstet Gynecol 2015;9(3):260-265.

Assessment of motoric and hemodynamic parameters in growth restricted fetuses – case study

Objective: In order to more accurately assess fetal neurological status in five fetuses with severe intrauterine growth restriction (IUGR), combined assessment of their hemodynamics and motor activity was undertaken in this study.Method: Hemodynamic changes in the placental and fetal cerebral vessels were evaluated using the umbilical artery resistance index (URI), and the middle cerebral artery resistance index (CRI). The blood flow redistribution towards the fetal brain in response to fetal hypoxia was detected by the C/U (cerebro – umbilical) ratio, expressed as CRI/URI.Motoric parameters were assessed by new antenatal neurologic scoring test named Kurjak Antenatal Neurodevelopmental Test (KANET), based on evaluation of spontaneous motor activity using four-dimensional (4D) ultrasound.Results: KANET has potential in recognizing pathologic and borderline behavior in IUGR fetuses with or without blood flow redistribution towards the fetal brain. Very low values of C/U ratio and abnormal KANET score have indicated adverse pregnancy outcome.Conclusion: In some pregnancies complicated with IUGR, estimation of the risk of hypoxia versus prematurity can be extremely puzzling. Combined assessment of hemodynamic and motoric parameters in IUGR fetuses could allow construction of an algorithm, which would be helpful in the decision making process of pregnancy termination.

The study of fetal neurobehavior in twins in all three trimesters of pregnancy

Aim: The aim was to assess the onset and the frequencies of the first intertwin contacts by four-dimensional ultrasound (4D US) in the 1st trimester of pregnancy. In the second part of the study, fetal behavior and Kurjak Antenatal Neurodevelopmental Test (KANET) score of twins compared to singletons in the 2nd and the 3rd trimesters was assessed.Patients and methods: Transvaginal 4D assessment was performed in 20 women in the 1st trimester between 56 and 69 postmenstrual days (PMD), while trans-abdominal approach was performed from 70 PMD onwards and at weekly intervals until 112 PMD. Fetal behavior was assessed by 4D UD US between 28 and 36 gestational weeks in 49 twin pregnancies.Results: The first intertwin contacts appeared at 61 PMD, while complex body movements appeared at 68 PMD. The complexity of intertwin contacts increased from 84 PMD. With increasing gestational age, a higher frequency of movements was observed. The number of abnormal, borderline, and normal KANET scores between singletons and twins was not statistically significant. Scores for isolated eye blinking, mouthing, grimacing, hand to head movement, finger movements, Gestalt perception and general movements differed significantly in twins and singletons.Conclusions: Two types of activities were observed: spontaneous and reactive. Although twins showed less activity and different behavioral pattern than singletons, a considerable proportion of overall motility was due to intertwin contacts.

Comparison between antenatal neurodevelopmental test and fetal Doppler in the assessment of fetal well being

The primary aim of this study was to compare circulatory changes in the fetal brain under certain pathological conditions with alterations in fetal behavior. A prospective longitudinal cohort study on fetal behavior of fetuses from singleton pregnancies between the 28th and 38th gestational week in the period from March 2009 to October 2011 was undertaken. There were 596 fetuses in the high-risk group and 273 fetuses in the low-risk group. Elevated umbilical artery Doppler pulsatility index and reduced middle cerebral artery pulsatility index obtained in the absence of fetal movements were considered abnormal. The Kurjak Antenatal Neurodevelopmental Test (KANET) was used to assess fetal behavior. Statistically significant differences in the distribution of normal, abnormal, and borderline KANET scores between low-risk and high-risk groups were found. Furthermore, 596 fetuses from the high-risk group were subdivided into subgroups according to the risk factor. The largest proportion of abnormal KANET scores (23.9%) was in the subgroup of fetuses whose mothers had an offspring diagnosed with cerebral palsy (23.9%), followed by the proportion of borderline KANET scores in the subgroup of fetuses from febrile mothers (12.7%). Fetal behavior was significantly different between the normal group and the following subgroups of fetuses: fetal growth restriction (FGR), gestational diabetes mellitus, threatened preterm birth, antepartal hemorrhage, maternal fever, sibling with cerebral palsy, and polyhydramnios. A new clinical application of the KANET test in early identification of fetuses at risk for adverse neurological outcome was demonstrated.

The role of 4-D ultrasonography in prenatal assessment of fetal neurobehaviour and prediction of neurological outcome

Objective. To determine the role of 4-D ultrasonography in prenatal assessment of fetal neurobehavior and in prediction of adverse neurological outcome.Design. Prospective cohort study.Setting. Women Hospital, Hamad Medical Corporation, Qatar.Population. Forty pregnant women between 20 and 38 weeks of gestation with high risk for neurological abnormalities and 40 low risk cases were included.Methods. Prenatal fetal neurological assessment using Kurjak antenatal neurodevelopmental test (KANET). Postnatal neurological assessment was performed using Amiel-Tison’s neurological assessment at term (ATNAT) for all live-borns.Main outcome measures. Prediction of fetuses at neurological risk.Results. The difference in the range of KANET score was significant. A significant difference was shown for isolated head anteflexion, isolated eye blinking, facial expressions, mouth movements, isolated hand movements, hand to face movement, finger movements, and general movements. For isolated leg movement and cranial sutures, the difference was not significant. All cases with abnormal KANET proved to be abnormal postnatally.Conclusion. 4-D ultrasonography may have an important role in prenatal assessment of fetal neurobehavior and prediction of adverse neurological outcome. However, further large studies are recommended before the test could be recommended for wider clinical practice.

The potential of 4D sonography in the assessment of fetal behavior in high-risk pregnancies

Objective. To assess differences of fetal behavior in normal and high-risk pregnancies.Methods. In the 1-year period (1 January 2007–31 December 2007), four-dimensional ultrasound has been used to assess Kurjak antenatal neurodevelopmental test (KANET) in low- and high-risk pregnancies after randomization in prospective longitudinal cohort study. Based on the KANET scores, the fetuses were considered as normal (≥14 points), borderline (6–13), or abnormal (0–5).Results. Comparison of KANET scores in low- and high-risk pregnancies were expectedly statistically significant. The largest incidence of fetuses with abnormal KANET was in the group of fetuses who had siblings with cerebral palsy. The largest incidence of the borderline KANET has been found in the group of fetuses whose mothers had fever during pregnancy. The following parameters of KANET test significantly differed between the fetuses from low- and high-risk pregnancies: overlapping cranial sutures, head circumference, isolated eye blinking, facial expressions, mouth movements, isolated hand movements, isolated leg movements, hand to face movement, finger movements, and general movements.Conclusion. KANET test has the potential to detect and discriminate normal from borderline and abnormal fetal behavior in normal and in high-risk pregnancies.