Measures of Functional Maturity

Neuromaturational changes in brain structural and functional development have been noted in preterm infants. These changes can be detected by detailed neurological examination, neuroimaging (especially cranial ultrasound), electroencephalography (EEG), amplitude-integrated EEG (a-EEG), electroretinography and neurophysiological measures of conduction time after auditory, visual, or tactile stimulation (Finnstrom, 1972; Miller et al., 1983; Henderson-Smart et al., 1985; Kesson et al., 1985; Klimach and Cooke, 1988; Leaf et al., 1995; Amiel-Tison and Gosselin, 2001; Burdjalov et al., 2003; Olischar et al., 2004; Allen, 2005a). Prenatal ultrasounds have detected sonographic landmarks of normal fetal cortical development, which is important to know for the prenatal detection of fetal brain malformations (Perri et al., 2005).

Wide variations in responses at each gestational age or postmenstrual age, and the need for special equipment and expertise for the most part limits their use for estimating gestational age at birth. However, current research focuses on using clinical and neurophysiological measures of neuromaturation (e.g., amplitude-integrated EEG and comprehensive neurodevelopmen-tal examinations) to assess ongoing development and integrity of the central nervous system (CNS) in high-risk preterm infants in a NICU (Allen, 2005a; Amiel-Tison, 2003; Burdjalov et al., 2003; Olischar et al., 2004). Better measures of fetal and infant neuromaturation have the potential to detect abnormalities; predict neurodevelopmental outcomes for more effective counseling of the parents and the more effective use of limited community resources; evaluate the effects of various prenatal and NICU interventions on CNS development; and provide insight into the various causes of CNS injury, neuroprotective factors, and mechanisms of CNS recovery after injury.

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