Deficiency of the Heterogeneous Nuclear Ribonucleoprotein U locus leads to delayed hindbrain neurogenesis

Genetic variants affecting Heterogeneous Nuclear Ribonucleoprotein U (HNRNPU) have been identified in several neurodevelopmental disorders (NDDs). HNRNPU is widely expressed in the human brain and shows the highest postnatal expression in the cerebellum. Recent studies have investigated the role of HNRNPU in cerebral cortical development, but the effects of HNRNPU deficiency on cerebellar development remain unknown. Here, we describe the molecular and cellular outcomes of HNRNPU locus deficiency during in vitro neural differentiation of patient-derived and isogenic neuroepithelial stem cells with a hindbrain profile. We demonstrate that HNRNPU deficiency leads to chromatin remodeling of A/B compartments, and transcriptional rewiring, partly by impacting exon inclusion during mRNA processing. Genomic regions affected by the chromatin restructuring and host genes of exon usage differences show a strong enrichment for genes implicated in epilepsies, intellectual disability, and autism. Lastly, we show that at the cellular level HNRNPU downregulation leads to an increased fraction of neural progenitors in the maturing neuronal population. We conclude that the HNRNPU locus is involved in delayed commitment of neural progenitors to differentiate in cell types with hindbrain profile.

Mammalian NREM and REM sleep: Why, when and how

This report proposes that fish use the spinal-rhombencephalic regions of their brain to support their activities while awake. Instead, the brainstem-diencephalic regions support the wakefulness in amphibians and reptiles. Lastly, mammals developed the telencephalic cortex to attain the highest degree of wakefulness, the cortical wakefulness. However, a paralyzed form of spinal-rhombencephalic wakefulness remains in mammals in the form of REMS, whose phasic signs are highly efficient in promoting maternal care to mammalian litter. Therefore, the phasic REMS is highly adaptive. However, their importance is low for singletons, in which it is a neutral trait, devoid of adaptive value for adults, and is mal-adaptive for marine mammals. Therefore, they lost it. The spinal-rhombencephalic and cortical wakeful states disregard the homeostasis: animals only attend their most immediate needs: foraging defense and reproduction. However, these activities generate allostatic loads that must be recovered during NREMS, that is a paralyzed form of the amphibian-reptilian subcortical wakefulness. Regarding the regulation of tonic REMS, it depends on a hypothalamic switch. Instead, the phasic REMS depends on an independent proportional pontine control.

Humans use minimum cost movements in a whole-body task

Humans have elegant bodies that allow gymnastics, piano playing, and tool use, but understanding how they do this in detail is difficult because their musculoskeletal systems are extraordinarily complicated. Nonetheless, common movements like walking and reaching can be stereotypical, and a very large number of studies have shown their energetic cost to be a major factor. In contrast, one might think that general movements are very individuated and intractable, but our previous study has shown that in an arbitrary set of whole-body movements used to trace large-scale closed curves, near-identical posture sequences were chosen across different subjects, both in the average trajectories of the body's limbs and in the variance within trajectories. The commonalities in that result motivate explanations for its generality. One explanation could be that humans also choose trajectories that are economical in cost. To test this hypothesis, we situate the tracing data within a forty eight degree of freedom human dynamic model that allows the computation of movement cost. Using the model to compare movement cost data from nominal tracings against various perturbed tracings shows that the latter are more energetically expensive, inferring that the original traces were chosen on the basis of minimum cost.

Maternal Mid-Gestation Cytokine Dysregulation in Mothers of Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a developmental disorder characterised by deficits in social interactions and communication, with stereotypical and repetitive behaviours. Recent evidence suggests that maternal immune dysregulation may predispose offspring to ASD. Independent samples t-tests revealed downregulation of IL-17A concentrations in cases, when compared to controls, at both 15 weeks (p = 0.02), and 20 weeks (p = 0.02), which persisted at 20 weeks following adjustment for confounding variables. This adds to the growing body of evidence that maternal immune regulation may play a role in foetal neurodevelopment.

Learning Through Shared Care : Allomaternal Care Impacts Cognitive Development in Early Infancy in a Western Population

This study investigates how allomaternal care (AMC) impacts human development outside of energetics by evaluating relations between important qualitative and quantitative aspects of AMC and developmental outcomes in a Western population. This study seeks to determine whether there are measurable differences in cognitive and language outcomes as predicted by differences in exposure to AMC via formal (e.g., childcare facilities) and informal (e.g., family and friends) networks. Data were collected from 102 mothers and their typically developing infants aged 13-18 months. AMC predictor data were collected using questionnaires, structured daily diaries, and longitudinal interviews. Developmental outcomes were assessed using the Cognitive, Receptive Language, and Expressive Language subtests of the Bayley III Screening Test. Additional demographic covariates were also evaluated. Akaike Information Criterion (AIC)-informed model selection was used to identify the best-fitting model for each outcome across three working linear regression models. Although AMC variables had no significant effects on Receptive and Expressive Language subtest scores, highly involved familial AMC had a significant medium effect on Cognitive subtest score (β = 0.23, p < 0.01, semi-partial r = 0.28). Formal childcare had no effect on any outcome. This study provides preliminary evidence that there is a measurable connection between AMC and cognitive development in some populations and provides a methodological base from which to assess these connections cross-culturally through future studies. As these effects are attributable to AMC interactions with networks of mostly related individuals, these findings present an area for further investigation regarding the kin selection hypothesis for AMC.

Prevalence and correlates of maternal early stimulation behaviors during pregnancy in northern Ghana: a cross-sectional survey

BACKGROUND

Per UNICEF's Nurturing Care Framework, early childhood development (ECD) begins during pregnancy and many lower-resource settings need data to inform their programs for optimal child development. The maternal-fetal relationship can be partly examined via a series of bonding activities called early stimulation behaviors (ESB). This study describes early stimulation behaviors and the associated correlates among pregnant women in Ghana.

METHODS

This cross-sectional study used data from a cluster-randomized trial in two districts of Northern Ghana. A total of 374 pregnant women were enrolled at baseline and administered a pre-intervention survey. Communication-related early stimulation behaviors was the primary outcome which was evaluated using three maternal-fetal bonding activities; did the woman self-report touching and/or talking, singing, and/or talking about family to her belly. A generalized estimating equation modified Poisson model was used for the bivariate and multivariable analysis.

RESULTS

About half of the participants reported performing communication-related ESB during pregnancy frequently or sometimes. Bivariate analysis revealed that negative life experiences including higher rates of emotional, physical and sexual intimate partner violence (IPV) and having moderate to severe depressive symptoms were associated with women performing early stimulation behaviors more often. In the multivariable model, physical intimate partner violence remained significantly associated with early stimulation behaviors.

CONCLUSION

Research on early stimulation behaviors is still in a nascent phase. It is unclear why our results revealed an association between intimate partner violence and early stimulation behaviors; this could reflect a coping mechanism for the expectant mother. Further research is needed to better understand this association and explore potential long-term impacts of early stimulation behaviors during pregnancy on child development.

TRIAL REGISTRATION

Clinical Trials # NCT03665246 , August 29, 2018.

Robust alternative to the righting reflex to assess arousal in rodents

The righting reflex (RR) is frequently used to assess level of arousal and applied to animal models of a range of neurological disorders. RR produces a binary result that, when positive, is used to infer restoration of consciousness, often without further behavioral corroboration. We find that RR is an unreliable metric for arousal/recovery of consciousness. Instead, cortical activity and motor behavior that accompany RR are a non-binary, superior criterion that accurately calibrates and establishes level of arousal in rodents.

Fetal eye movements in response to a visual stimulus

INTRODUCTION

In 2D ultrasound, the lens of the fetal eye can be distinguished as white circles within the hypoechoic eyeball, and eye movements can be visualized from about 15 weeks' gestation. It has been shown that from 31 weeks gestational age the fetal sensory system is capable of directed vision if enough light is available.

METHODS

We have developed a light source for delivering visual stimuli to be seen by the fetal eye, using laser dot diodes emitting at 650 nm. The 2D component of 94 fetal ultrasound scans (mean gestational age 240 days), where the light stimulus was presented, was coded to determine whether the eyes moved in response to the stimuli independent of any head movement.

RESULTS

The light stimulus significantly provoked head and eye movements, but after the light was withdrawn the head stopped moving, yet the eyes continued to move.

CONCLUSION

This provides evidence for visual attention mechanisms that can be controlled through eye movements that are independent of head movements prior to birth.

Depression in Children and Adolescents Involved in the Child Welfare System

Child maltreatment presents a significant public health challenge and is strongly associated with development of depression during childhood and adolescence. Not all abused or neglected children are in the child welfare system, but most children in the foster care system have a history of maltreatment. Involvement with the child welfare system presents an additional risk for psychopathology. The role of child maltreatment and child welfare involvement in development of depression in children and adolescents is reviewed and effective treatments are discussed. Clinicians working with foster children must collaborate with care providers and other stakeholders to enhance the child's placement permanence.

A Meta-Analysis of Maternal Prenatal Depression and Anxiety on Child Socioemotional Development

OBJECTIVE

Observed associations between maternal prenatal stress and children's socioemotional development have varied widely in the literature. The objective of the current study was to provide a synthesis of studies examining maternal prenatal anxiety and depression and the socioemotional development of their children.

METHOD

Eligible studies through to February 2018 were identified using a comprehensive search strategy. Included studies examined the association between maternal prenatal depression or anxiety and the future development of their children's socioemotional development (eg, difficult temperament, behavioral dysregulation) up to 18 years later. Two independent coders extracted all relevant data. Random-effects meta-analyses were used to derive mean effect sizes and test for potential moderators.

RESULTS

A total of 71 studies met full inclusion criteria for data analysis. The weighted average effect size for the association between prenatal stress and child socioemotional problems was as follows: odds ratio (OR) = 1.66 (95% CI = 1.54-1.79). Effect sizes were stronger for depression (OR = 1.79; 95% CI = 1.61-1.99) compared to anxiety (OR = 1.50; 95% CI = 1.36-1.64). Moderator analyses indicated that effect sizes were stronger when depression was more severe and when socio-demographic risk was heightened.

CONCLUSION

Findings suggest that maternal prenatal stress is associated with offspring socioemotional development, with the effect size for prenatal depression being more robust than for anxiety. Mitigating stress and mental health difficulties in mothers during pregnancy may be an effective strategy for reducing offspring behavioral difficulties, especially in groups with social disadvantage and greater severity of mental health difficulties.

Outcomes following severe hand foot and mouth disease: A systematic review and meta-analysis

BACKGROUND

Hand, foot and mouth disease (HFMD) caused by enterovirus A71 (EV-A71) is associated with acute neurological disease in children. This study aimed to estimate the burden of long-term sequelae and death following severe HFMD.

METHODS

This systematic review and meta-analysis pooled all reports from English and Chinese databases including MEDLINE and Wangfang on outbreaks of clinically diagnosed HFMD and/or laboratory-confirmed EV-A71 with at least 7 days' follow-up published between 1st January 1966 and 19th October 2015. Two independent reviewers assessed the literature. We used a random effects meta-analysis to estimate cumulative incidence of neurological sequelae or death. Studies were assessed for methodological and reporting quality. PROSPERO registration number: 10.15124/CRD42015021981.

FINDINGS

43 studies were included in the review, and 599 children from 9 studies were included in the primary analysis. Estimated cumulative incidence of death or neurological sequelae at maximum follow up was 19.8% (95% CI:10.2%, 31.3%). Heterogeneity (Iˆ2) was 88.57%, partly accounted for by year of data collection and reporting quality of studies. Incidence by acute disease severity was 0.00% (0.00, 0.00) for grade IIa; 17.0% (7.9, 28.2) for grade IIb/III; 81.6% (65.1, 94.5) for grade IV (p = 0.00) disease.

CONCLUSIONS

HFMD with neurological involvement is associated with a substantial burden of long-term neurological sequelae. Grade of acute disease severity was a strong predictor of outcome. Strengths of this study include its bilingual approach and clinical applicability. Future prospective and interventional studies must use rigorous methodology to assess long-term outcomes in survivors.

FUNDING

There was no specific funding for this study. See below for researcher funding.

4D ultrasound study of fetal facial expressions in the third trimester of pregnancy

OBJECTIVE

To evaluate the frequencies of fetal facial expressions in the third trimester of pregnancy, when fetal brain maturation and development are progressing in normal healthy fetuses.

METHODS

Four-dimensional (4 D) ultrasound was used to examine the facial expressions of 111 healthy fetuses between 30 and 40 weeks of gestation. The frequencies of seven facial expressions (mouthing, yawning, smiling, tongue expulsion, scowling, sucking, and blinking) during 15-minute recordings were assessed. The fetuses were further divided into three gestational age groups (25 fetuses at 30-31 weeks, 43 at 32-35 weeks, and 43 at ≥36 weeks). Comparison of facial expressions among the three gestational age groups was performed to determine their changes with advancing gestation.

RESULTS

Mouthing was the most frequent facial expression at 30-40 weeks of gestation, followed by blinking. Both facial expressions were significantly more frequent than the other expressions (p < .05). The frequency of yawning decreased with the gestational age after 30 weeks of gestation (p = .031). Other facial expressions did not change between 30 and 40 weeks. The frequency of yawning at 30-31 weeks was significantly higher than that at 36-40 weeks (p < .05). There were no significant differences in the other facial expressions among the three gestational age groups.

CONCLUSIONS

Our results suggest that 4D ultrasound assessment of fetal facial expressions may be a useful modality for evaluating fetal brain maturation and development. The decreasing frequency of fetal yawning after 30 weeks of gestation may explain the emergence of distinct states of arousal.

Fetal Development: Voice Processing in Normotensive and Hypertensive Pregnancies

Recent observation of maternal voice recognition provides evidence of rudimentary memory and learning in healthy term fetuses. However, such higher order auditory processing has not been examined in the presence of maternal hypertension, which is associated with reduced and/or impaired uteroplacental blood flow. In this study, voice processing was examined in 40 fetuses (gestational ages of 33 to 41 weeks) of hypertensive and normotensive women. Fetuses received 2 min of no sound, 2 min of a tape-recorded story read by their mothers or by a female stranger, and 2 min of no sound while fetal heart rate was recorded. Results demonstrated that fetuses in the normotensive group had heart rate accelerations during the playing of their mother's voice, whereas the response occurred in the hypertensive group following maternal voice offset. Across all fetuses, a greater fetal heart rate change was observed when the amniotic fluid index was above compared to below the median (i.e., 150 mm), indicating that amniotic fluid volume may be an independent moderator of fetal auditory sensitivity. It was concluded that differential fetal responding to the mother's voice in pregnancies complicated by maternal hypertension may reflect functional elevation of sensorineural threshold or a delay in auditory system maturation, signifying functional differences during fetal life or subtle differences in the development of the central nervous system.

Lessons From Reparative Therapy Applied to Post-Abortion Grief Counseling

There is evidence from the legislative, judicial, and counseling sectors that the sun is setting on therapies designed to change sexual orientation. Despite this evidence, there is also evidence that similar pseudoscientific interventions continue to be used in at least one other area-post-abortion counseling. The key factor shared by both interventions is their dependence on unvalidated explanations of behavior. In the case of changing the expression of sexual orientation, the harm at the personal and communal levels is clear. In the case of post-abortion counseling, the harm is hypothesized, and the reasons why a communal response is lacking in the post-abortion community are described. Steps clinicians can take to alleviate the probable harm caused by the use of unvalidated/unvalidatable interventions, with a particular emphasis on identifying and expunging culturally derived and oppressive interventions currently used, are delineated as clinical and social justice activities to reduce human suffering.

Fetal Neurology: The Role of Fetal Stress

Fetal development and growth, as well as the timing of birth is influenced by the intrauterine environment. Many environmental factors causing the fetal stress can interfere with fetal development and leave long-term and profound consequences on health. Fetal glucocorticoid overexposure has primarily significant consequences for the development of the central nervous system. In response to an adverse intrauterine conditions, the fetus is able to adapt its physiology to promote survival. However, these adaptations can result in permanent changes in tissue and organ structure and function that directly ‘program’ predisposition to disease. Cardiometabolic disorders, behavioral alterations and neuropsychiatric impairments in adulthood and/ or childhood may have their roots in the fetal period of life. Fetal response to stress and its prenatal and lifelong consequences are discussed in this review.

How to cite this article

Kadić AS. Fetal Neurology: The Role of Fetal Stress. Donald School J Ultrasound Obstet Gynecol 2015;9(1):30-39.

Fetal Neurology: Past, Present and Future

Neurological failure is the most apprehension complication of pregnancy, labor and the neonatal period. The origin and outcome correlation is frequently doubtful. The arrival of four-dimensional ultrasonography (4D US) and its function to study fetal behavior patterns have initiated to offer insight into the structural and functional fetal brain development. Although many fetal behavioral studies have been conducted, it is still questionable whether the assessment of continuity from fetal to neonatal behavior could improve our ability of early detection of brain pathology. Neurological assessment of fetus in utero is extremely difficult even having such sophisticated equipment like 4D ultrasound. As it is well known that quantity of GMs is not so informative and predictive for neurological impairment, their quality should be assessed. Gestalt perception of premature GMs we are dealing with in utero and several weeks postnatally are not as predictive for the detection of neurologically abnormal fetuses or newborns as fidgety GMs. Therefore, some additional parameters should be added to the prenatal neurological examination in order to improve our ability to make the distinction between normal and abnormal fetuses.

How to cite this article

Kurjak A, Antsaklis P, Stanojevic M. Fetal Neurology: Past, Present and Future. Donald School J Ultrasound Obstet Gynecol 2015;9(1):6-29.

Recent Results of the Clinical Application of Kanet Test

Many investigations led to the conclusion that fetal behavioral patterns directly reflect developmental and maturational processes of fetal central nervous system (CNS), and may make possible to distinguish between normal and abnormal brain development as well as prenatal diagnosis of neurological impairment. The arrival of three- and four-dimensional ultrasound (3D/4D US) made possible to study fetal behavioral patterns. Kurjak's antenatal neurodevelopmental test (KANET) is the first prenatal test based on 3D/4D ultrasound examination of the fetus, that could be used for the evaluation and prediction of fetal neurological status. Here, we present our review of literature on KANET around the world and summarized results of this promising prenatal neurological screening test.

How to cite this article

Neto RM, Kurjak A. Recent Results of the Clinical Application of Kanet Test. Donald School J Ultrasound Obstet Gynecol 2015;9(4):420-425.

Fetal functional imaging portrays heterogeneous development of emerging human brain networks

The functional connectivity architecture of the adult human brain enables complex cognitive processes, and exhibits a remarkably complex structure shared across individuals. We are only beginning to understand its heterogeneous structure, ranging from a strongly hierarchical organization in sensorimotor areas to widely distributed networks in areas such as the parieto-frontal cortex. Our study relied on the functional magnetic resonance imaging (fMRI) data of 32 fetuses with no detectable morphological abnormalities. After adapting functional magnetic resonance acquisition, motion correction, and nuisance signal reduction procedures of resting-state functional data analysis to fetuses, we extracted neural activity information for major cortical and subcortical structures. Resting fMRI networks were observed for increasing regional functional connectivity from 21st to 38th gestational weeks (GWs) with a network-based statistical inference approach. The overall connectivity network, short range, and interhemispheric connections showed sigmoid expansion curve peaking at the 26-29 GW. In contrast, long-range connections exhibited linear increase with no periods of peaking development. Region-specific increase of functional signal synchrony followed a sequence of occipital (peak: 24.8 GW), temporal (peak: 26 GW), frontal (peak: 26.4 GW), and parietal expansion (peak: 27.5 GW). We successfully adapted functional neuroimaging and image post-processing approaches to correlate macroscopical scale activations in the fetal brain with gestational age. This in vivo study reflects the fact that the mid-fetal period hosts events that cause the architecture of the brain circuitry to mature, which presumably manifests in increasing strength of intra- and interhemispheric functional macro connectivity.

Auditory pathway maturational study in small for gestational age preterm infants

PURPOSE

To follow up the maturation of the auditory pathway in preterm infants small for gestational age (SGA), through the study of absolute and interpeak latencies of auditory brainstem response (ABR) in the first six months of age.

METHODS

This multicentric prospective cross-sectional and longitudinal study assessed 76 newborn infants, 35 SGA and 41 appropriate for gestational age (AGA), born between 33 and 36 weeks in the first evaluation. The ABR was carried out in three moments (neonatal period, three months and six months). Twenty-nine SGA and 33 AGA (62 infants), between 51 and 54 weeks (corrected age), returned for the second evaluation. In the third evaluation, 49 infants (23 SGA and 26 AGA), with age range from 63 to 65 weeks (corrected age), were assessed. The bilateral presence of Transient Evoked Otoacoustic Emissions and normal tympanogram were inclusion criteria.

RESULTS

It was found interaural symmetry in both groups. The comparison between the two groups throughout the three periods studied showed no significant differences in the ABR parameters, except for the latencies of wave III in the period between three and six months. As for the maturation with tone burst 0.5 and 1 kHz, it was found that the groups did not differ.

CONCLUSION

The findings suggest that, in the premature infants, the maturational process of the auditory pathway occurs in a similar rate for SGA and AGA. These results also suggest that prematurity is a more relevant factor for the maturation of the auditory pathway than birth weight.

Longitudinal electrophysiological study of auditory pathway in small for gestational age infants

PURPOSE

To follow the maturation of the auditory pathway of infants born small for gestational age term, by studying absolute and interpeak latencies of Auditory Brainstem Response (ABR) in the first six months of life.

METHODS

Multicentric prospective longitudinal study. The ABR was carried out in the neonatal period in 96 newborn infants, 49 small for gestational age (SGA) and 47 appropriate for gestational age (AGA). Of these, 77 infants (39 SGA and 38 AGA) returned for a second evaluation. In the third evaluation, 70 infants (35 SGA and 35 AGA) returned.

RESULTS

SGA and AGA did not present significant differences in the neonatal period and at three months of life. However, at six months, there was statistical significant difference between SGA and AGA groups for the latencies of wave III and interpeak I-III. Latencies of ABR waves decreased more rapidly in the first three months than the third to the sixth month of life for the SGA. AGA group showed progressive decrease in latency of ABR waves during the six months.

CONCLUSION

The findings suggest that, for SGA infants, the maturational process of the auditory pathway occurs in different rate when compared to AGA infants. The SGA infants have faster maturation especially at the first three months of life, while in infants AGA, this process occurred in a constant and gradual way throughout the six months studied.

Fetal eye movements on magnetic resonance imaging

Objectives

Eye movements are the physical expression of upper fetal brainstem function. Our aim was to identify and differentiate specific types of fetal eye movement patterns using dynamic MRI sequences. Their occurrence as well as the presence of conjugated eyeball motion and consistently parallel eyeball position was systematically analyzed.

Methods

Dynamic SSFP sequences were acquired in 72 singleton fetuses (17–40 GW, three age groups [17–23 GW, 24–32 GW, 33–40 GW]). Fetal eye movements were evaluated according to a modified classification originally published by Birnholz (1981): Type 0: no eye movements; Type I: single transient deviations; Type Ia: fast deviation, slower reposition; Type Ib: fast deviation, fast reposition; Type II: single prolonged eye movements; Type III: complex sequences; and Type IV: nystagmoid.

Results

In 95.8% of fetuses, the evaluation of eye movements was possible using MRI, with a mean acquisition time of 70 seconds. Due to head motion, 4.2% of the fetuses and 20.1% of all dynamic SSFP sequences were excluded.

Eye movements were observed in 45 fetuses (65.2%). Significant differences between the age groups were found for Type I (p = 0.03), Type Ia (p = 0.031), and Type IV eye movements (p = 0.033). Consistently parallel bulbs were found in 27.3–45%.

Conclusions

In human fetuses, different eye movement patterns can be identified and described by MRI in utero. In addition to the originally classified eye movement patterns, a novel subtype has been observed, which apparently characterizes an important step in fetal brainstem development. We evaluated, for the first time, eyeball position in fetuses. Ultimately, the assessment of fetal eye movements by MRI yields the potential to identify early signs of brainstem dysfunction, as encountered in brain malformations such as Chiari II or molar tooth malformations.

Modeling the minimal newborn's intersubjective mind: the visuotopic-somatotopic alignment hypothesis in the superior colliculus

The question whether newborns possess inborn social skills is a long debate in developmental psychology. Fetal behavioral and anatomical observations show evidences for the control of eye movements and facial behaviors during the third trimester of pregnancy whereas specific sub-cortical areas, like the superior colliculus (SC) and the striatum appear to be functionally mature to support these behaviors. These observations suggest that the newborn is potentially mature for developing minimal social skills. In this manuscript, we propose that the mechanism of sensory alignment observed in SC is particularly important for enabling the social skills observed at birth such as facial preference and facial mimicry. In a computational simulation of the maturing superior colliculus connected to a simulated facial tissue of a fetus, we model how the incoming tactile information is used to direct visual attention toward faces. We suggest that the unisensory superficial visual layer (eye-centered) and the deep somatopic layer (face-centered) in SC are combined into an intermediate layer for visuo-tactile integration and that multimodal alignment in this third layer allows newborns to have a sensitivity to configuration of eyes and mouth. We show that the visual and tactile maps align through a Hebbian learning stage and and strengthen their synaptic links from each other into the intermediate layer. It results that the global network produces some emergent properties such as sensitivity toward the spatial configuration of face-like patterns and the detection of eyes and mouth movement.

Fetal neurophysiology according to gestational age

More than 99% of the human neocortex is fashioned during intrauterine life, resulting in the fascinating diversity of fetal functions and activities. The objective of this review is to present the most significant neurodevelopmental events, as well as new findings about prenatal motor and sensory development.

Fetal habituation in assisted conception

BACKGROUND

Neurodevelopment outcomes of children conceived by Assisted Reproductive Technology (ART)have been the subject of much recent attention. To date there are no reports of neurodevelopmental performance before birth in this group.

AIMS

To compare habituation (a measure of brain function) in fetuses conceived by assisted reproduction techniques (ART) with naturally conceived (NC) fetuses.

STUDY DESIGN

Case control study.

SUBJECTS

Women with singleton pregnancies matched for maternal age, parity and smoking were recruited in 2 groups: ART (n=20) and NC (n=20).

OUTCOME MEASURES

Sound stimuli (250 Hz, 110 dB) at 10 second intervals lasting 2 s were administered to the fetus. The end point was habituation (cessation of movement for five consecutive stimuli) or a maximum of 30 stimuli. Responses of the fetus were observed with ultrasound at 28, 32 and 36 weeks' gestation, video-recorded and anonymised for analysis.

RESULTS

At 28 weeks' gestation significantly more ART fetuses responded to sound of 250 Hz, 110 dB (p=0.02) but this difference did not persist at 32 and 36 weeks'. There was a significant increase in nonresponders as gestation advanced in the ART group. There was no difference in habituation or mean number of trials to habituate at all three gestations.

CONCLUSIONS

ART fetuses demonstrated no differences in habituation suggesting that there is no neurodevelopment delay. However, a decrease in response to sound as gestation advances might be a harbinger for poor perinatal outcomes and needs exploration.

The relationship of age, gender, and IQ with the brainstem and thalamus in healthy children and adolescents: a magnetic resonance imaging volumetric study

In healthy children, there is a paucity of information on the growth of the brainstem and thalamus measured anatomically magnetic resonance imaging. The relations of age, gender, and age by gender with brainstem and thalamus volumes were analyzed from magnetic resonance brain images of 122 healthy children and adolescents (62 males, 60 females; ages 4 to 17). Results showed that age is a significant predictor of brainstem and thalamus volumes. The volume of the brainstem increases with age, while thalamus volume declines with age. The volume of the right thalamus is significantly larger than that of the left in both genders, with greater rightward asymmetry and greater thalamus to grey matter ratio in females. Males have larger brainstems, but these differences are not significant when covarying for cerebral volume. Larger thalami were associated with higher Verbal IQ. These normative pediatric data are of value to researchers who study these regions in neurodevelopmental disorders.

Sex differences in fetal habituation

There is some evidence for sex differences in habituation in the human fetus, but it is unknown whether this is due to differences in central processing (habituation) or in more peripheral processes, sensory or motor, involved in the response. This study examined whether the sex of the fetus influenced auditory habituation at 33 weeks of gestation, and whether this was due to differences in habituation or in the sensory or motor components using a set of four experiments. The first experiment found that female fetuses required significantly fewer stimulus presentations to habituate than males. The second experiment revealed no difference in the spontaneous motor behaviour of male and female fetuses. The third experiment examined auditory intensity thresholds for the stimuli used to habituate the fetus. No differences in thresholds were found between males and females, although there was inter-individual variability in thresholds. A final experiment, using stimuli individualized for that particular fetus' auditory intensity threshold, found that female fetuses habituated faster than males. In combination, the studies reveal that habituation in the human fetus is affected by sex and this is due to a difference in central 'information processing' of the stimuli rather than peripheral aspects of the response. It is argued that male and female fetuses present different neurobehavioural developmental trajectories, with females more advanced at 33 weeks than males. This study suggests that research examining prenatal behaviour should consider the factor of fetal sex. This may be particularly pertinent where there is an intention to use the results diagnostically.

The effect of dimensionality on growth and differentiation of neural progenitors from different regions of fetal rat brain in vitro: 3-dimensional spheroid versus 2-dimensional monolayer culture

Three-dimensional (3-D) spheroids are widely used for culturing cells. However, 2-dimensional (2-D) monolayer cultures have also been adopted for culture and used in a broad range of cell biology studies. To address the effect of dimensionality on the growth and differentiation of neuroprogenitor cells in 3-D spheroids and 2-D monolayer cultures, cells were isolated from cerebral cortex, cerebella and brainstem of fetal rat brain then cultured in serum-free DMEM/F12 medium or DMEM with 10% FBS. The growth and differentiation of neuroprogenitor cells from three brain regions in spheroids was compared with that in monolayer cultures, and the differentiation components of neuroprogenitor cells were compared with in vivo brain sections. Neuroprogenitor cells in spheroids proliferate actively over 10 days in culture as showed by Ki67 incorporation and increase in spheroid diameter. More neuroprogenitor cells underwent neuronal differentiation in spheroids than in monolayer cultures. In comparison with fixed rat brain sections, the neuron to astrocyte ratio, as shown by neurofilament to glial fibrillary acidic protein immunoreactivity, in spheroids is similar to that found in adult rat tissue sections. Our results suggest that the spheroid culture system mimics the in vivo cytoarchitecture to a greater extent and more closely reflects the cellular composition in adult brain tissue. This supports the notion that the intercellular niche in spheroids is more favorable for the survival and differentiation of neuronal precursors, while the cues in monolayer cultures may favor glial cell survival. It is therefore concluded that dimensionality plays a significant role in determining cellular behavior in vitro.

What We have Learned from Fetal Neurophysiology?

The nervous system is one of the earliest emerging systems in fetal development. Due to progress of modern imaging technologies, such as ultrasound, a growing pool of information on the development of the central nervous system (CNS) and fetal behavioral patterns has been made available. The major events in the development of the CNS, fetal motor and sensory development as well as fetal response to stress are discussed in this review. The fetus is not entirely protected from harmful influence of the external factors. Postnatal follow-up studies have showed that many environmental influences causing the fetal stress can interfere with the fetal neurodevelopment and leave long-term and profound consequences on brain structure and function.

How to cite this article

SalihagićKadić A, Predojevic M. What We have Learned from Fetal Neurophysiology? Donald School J Ultrasound Obstet Gynecol 2012;6(2):179-188.

4D Sonography in Assessment of Fetal Neurobehavior

‘Observation of fetal behavior reflects the functioning of the central nervous system, and behavioral assessment of the fetus enables the function of the brain to be examined’.1 The introduction of four-dimensional (4D) sonography techniques would facilitate fetal behavioral assessment in three dimensions in real time during pregnancy. We describe the latest 4D sonographic studies on fetal neurobehavior in all three trimesters of pregnancy. 4D sonography also facilitated the evaluation of interhuman contact and intrapair stimulation in twin pregnancies in utero. This novel technique may assist in the evaluation of fetal neurobehavior and intertwin contact and intrapair stimulation and offer potential advantages relative to conventional two-dimensional sonography. 4D sonography may become an important modality in future research on fetal neurobehavioral development and the prenatal identification of severely brain-damaged infants.

How to cite this article

Hata T, Sato M, Kanenishi K, Hanaoka U, Tanaka H. 4D Sonography in Assessment of Fetal Neurobehavior. Donald School J Ultrasound Obstet Gynecol 2012;6(2):121-131.

Putting together phylogenetic and ontogenetic perspectives on empathy

The ontogeny of human empathy is better understood with reference to the evolutionary history of the social brain. Empathy has deep evolutionary, biochemical, and neurological underpinnings. Even the most advanced forms of empathy in humans are built on more basic forms and remain connected to core mechanisms associated with affective communication, social attachment, and parental care. In this paper, we argue that it is essential to consider empathy within a neurodevelopmental framework that recognizes both the continuities and changes in socioemotional understanding from infancy to adulthood. We bring together neuroevolutionary and developmental perspectives on the information processing and neural mechanisms underlying empathy and caring, and show that they are grounded in multiple interacting systems and processes. Moreover, empathy in humans is assisted by other abstract and domain-general high-level cognitive abilities such as executive functions, mentalizing and language, as well as the ability to differentiate another's mental states from one's own, which expand the range of behaviors that can be driven by empathy.

Mother's anxiety and depression during the third pregnancy trimester and neonate's mother versus stranger's face/voice visual preference

BACKGROUND

Neonates show visual preference for their mother's face/voice and shift their attention from their mother to a stranger's face/voice after habituation.

AIM

To assess neonate's mother versus stranger's face/voice visual preference, namely mother's anxiety and depression during the third pregnancy trimester and neonate's: 1) visual preference for the mother versus the stranger's face/voice (pretest visual preference), 2) habituation to the mother's face/voice and 3) visual preference for the stranger versus the mother's face/voice (posttest visual preference).

METHOD

Mothers (N=100) filled out the Edinburgh Postnatal Depression Scale (EPDS) and the State Anxiety Inventory (STAI) both at the third pregnancy trimester and childbirth, and the "preference and habituation to the mother's face/voice versus stranger" paradigm was administered to their newborn 1 to 5 days after childbirth.

RESULTS

Neonates of anxious/depressed mothers during the third pregnancy trimester contrarily to neonates of non-anxious/non-depressed mothers did not look 1) longer at their mother's than at the stranger's face/voice at the pretest visual preference (showing no visual preference for the mother), nor 2) longer at the stranger's face/voice in the posttest than in the pretest visual preference (not improving their attention to the stranger's after habituation).

CONCLUSION

Infants exposed to mother's anxiety/depression at the third gestational trimester exhibit less perceptual/social competencies at birth.

Four-dimensional Ultrasound Evaluation of Fetal Neurobehavioral Development

The introduction of four-dimensional (4D) ultrasound techniques would facilitate fetal behavioral assessment in three-dimensions in realtime during pregnancy. We describe the latest 4D sonographic studies on fetal behavior, especially fetal whole-body movements and facial expressions in all three trimesters of pregnancy and the continuation of behavior from the fetal to neonatal period. Moreover, we introduce a new scoring system (KANET, Kurjak Antenatal Neurological Test) for assessment of the fetal neurological status using 4D ultrasound. 4D ultrasound also facilitated the evaluation of inter-human contact in twin pregnancies in utero. This novel technique may assist in the evaluation of fetal behavior and inter-twin contact, and offer potential advantages relative to conventional two-dimensional ultrasound. 4D ultrasound should become an important modality in future research on fetal neurobehavioral development and the prenatal identification of severely brain-damaged infants. Further studies involving a larger sample size are needed to ascertain the role of 4D ultrasound in the evaluation of fetal neurobehavioral development.

Maturation of the human fetal startle response: evidence for sex-specific maturation of the human fetus

Despite the evidence for early fetal experience exerting programming influences on later neurological development and health risk, very few prospective studies of human fetal behavior have been reported. In a prospective longitudinal study, fetal nervous system maturation was serially assessed by monitoring fetal heart rate (FHR) responses to vibroacoustic stimulation (VAS) in 191 maternal/fetal dyads. Responses were not detected at 26 weeks gestational age (GA). Sex-specific, age-characteristic changes in the FHR response to VAS were observed by 31 weeks' GA. Males showed larger responses and continued to exhibit maturational changes until 37 weeks' GA, females however, presented with a mature FHR startle response by 31 weeks' GA. The results indicate that there are different rates of maturation in the male and female fetuses that may have implications for sex-specific programming influences.

Repetition Suppression of Induced Gamma Activity Predicts Enhanced Orienting toward a Novel Stimulus in 6-month-old Infants

Habituation refers to a decline in orienting or responding to a repeated stimulus, and can be inferred to reflect learning about the properties of the repeated stimulus when followed by increased orienting to a novel stimulus (i.e., novelty detection). Habituation and novelty detection paradigms have been used for over 40 years to study perceptual and mnemonic processes in the human infant, yet important questions remain about the nature of these processes in infants. The aim of the present study was to examine the neural mechanisms underlying habituation and novelty detection in infants. Specifically, we investigated changes in induced alpha, beta, and gamma activity in 6-month-old infants during repeated presentations of either a face or an object, and examined whether these changes predicted behavioral responses to novelty at test. We found that induced gamma activity over occipital scalp regions decreased with stimulus repetition in the face condition but not in the toy condition, and that greater decreases in the gamma band were associated with enhanced orienting to a novel face at test. The pattern and topography of these findings are consistent with observations of repetition suppression in the occipital–temporal visual processing pathway, and suggest that encoding in infant habituation paradigms may reflect a form of perceptual learning. Implications for the role of repetition suppression in infant habituation and novelty detection are discussed with respect to a biased competition model of visual attention.

Fetal cortical activation to sound at 33 weeks of gestation: a functional MRI study

Hearing already functions before birth, but little is known about the neural basis of fetal life experiences. Recent imaging studies have validated the use of functional magnetic resonance imaging (fMRI) in pregnant women at 38-weeks of gestation. The aim of the present study was to examine fetal brain activation to sound, using fMRI at the beginning of the third trimester of pregnancy. 6 pregnant women between 28- and 34-weeks of gestation were scanned using a magnetic strength of 1.5 T, with an auditory stimulus applied to their abdomen. 3 fetuses with a gestational age of 33 weeks, showed significant activation to sound in the left temporal lobe, measured using a new data-driven approach (Independent Component Analysis for fMRI time series). Only 2 of these fetuses showed left temporal activation, when the standard voxel-wise analysis method was used (p=0.007; p=0.001). Moreover, motion parameters added as predictors of the General Linear Model confirmed that motion cannot account for the signal variance in the fetal temporal cortex (p=0.01). Comparison between the statistical maps obtained from MRI scans of the fetuses with those obtained from adults, made it possible to confirm our hypothesis, that there is brain activation in the primary auditory cortex in response to sound. Measurement of the fetal hemodynamic response revealed an average fMRI signal change of +3.5%. This study shows that it is possible to use fMRI to detect early fetal brain function, but also confirms that sound processing occurs beyond the reflexive sub-cortical level, at the beginning of the third trimester of pregnancy.

Active caspase-3 in the sudden infant death syndrome (SIDS) brainstem

In a retrospective postmortem study, we examined the neuronal expression of active caspase-3, a specific apoptotic marker, in the brainstem of 67 infants dying from sudden infant death syndrome (SIDS), and 25 age-matched control infants (non-SIDS). Neuronal immunostaining for active caspase-3 was semi-quantitatively scored in nuclei from five brainstem levels: rostral, mid and caudal pons, and rostral and caudal medulla. Regardless of the cause of death (SIDS vs. non-SIDS), age-related differences in active caspase-3 expression were identified, predominantly in the medulla. No gender-related differences were identified. Comparing SIDS to non-SIDS cases, increased active caspase-3 expression was restricted to four nuclei in the caudal pons (abducens, facial, superior olivary, and pontine nuclei) and two nuclei in the rostral medulla (hypoglossal and dorsal motor nucleus of the vagus). We conclude that neuronal apoptosis is increased in the brainstem of SIDS compared to non-SIDS infants.

Normal standards of fetal behavior assessed by four-dimensional sonography

OBJECTIVE

In this prospective randomized study, fetal behavior was investigated in order to determine the standard parameters of fetal movements and facial expressions in all three trimesters of normal pregnancy.

METHODS

Sixty-three pregnant women with singleton pregnancies in all trimesters were included in the investigation. Four-dimensional (4D) ultrasound was performed for each patient over a 30-minute period. Variables of maternal and fetal characteristics including gestational age, eight fetal movement patterns in the first trimester, and sixteen parameters of fetal movement and fetal facial expression patterns in the second and third trimesters were recorded for the construction of fetal neurological charts.

RESULTS

In the first trimester, a tendency towards an increased frequency of fetal movement patterns with increasing gestational age was noticed. Only the startle movement pattern seemed to occur stagnantly during the first trimester (p > 0.05). At the beginning of the second trimester, the frequency of fetal movement patterns tended to increase. During the second and third trimester, multiple regression and polynomial regression revealed statistically significant changes in tongue expulsion (p < 0.05), smiling (p < 0.05), grimacing (p < 0.05), swallowing (p < 0.05), eye blinking (p < 0.01), head movements, and all hand to body contact movements (p < 0.01), except for head anteflexion (p > 0.05). There were no statistically significant changes during the second and third trimesters in mouthing, yawning, and sucking (p > 0.05). At the middle of the third trimester, the fetuses displayed decreasing or stagnant incidence of fetal facial expressions except for eye blinking, which showed increased frequency with increasing gestational age. A statistically significant correlation was found between all head movements and hand to body contact patterns during the second and third trimesters except for head anteflexion (r = -0.231; p > 0.05).

CONCLUSIONS

The full range of quantitative fetal facial expressions and fetal movement patterns can be assessed successfully by 4D sonography. It is important to be able to assess normal fetal behavior throughout gestation to identify abnormal behavior before birth.

Auditory processing deficits in growth restricted fetuses affect later language development

An increased risk for language deficits in infants born growth restricted has been reported in follow-up studies for more than 20 years, suggesting a relation between fetal auditory system development and later language learning. Work with animal models indicate that there are at least two ways in which growth restriction could affect the development of auditory perception in human fetuses: a delay in myelination or conduction and an increase in sensorineural threshold. Systematic study of auditory function in growth restricted human fetuses has not been reported. However, results of studies employing low-risk fetuses delivering as healthy full-term infants demonstrate that, by late gestation, the fetus can hear, sound properties modulate behavior, and sensory information is available from both inside (e.g., maternal vascular) and outside (e.g., noise, voices, music) of the maternal body. These data provide substantive evidence that the auditory system is functioning and that environmental sounds are available for shaping neural networks and laying the foundation for language acquisition before birth. We hypothesize that fetal growth restriction affects auditory system development, resulting in atypical auditory information processing in growth restricted fetuses compared to healthy, appropriately-grown-for-gestational-age fetuses. Speech perception that lays the foundation for later language competence will differ in growth restricted compared to normally grown fetuses and be associated with later language abilities.