Allen Marilee C
Department of Pediatrics, Eudowood Division of Neonatology, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287-3200, USA.
Ment Retard Dev Disabil Res Rev. 2005;11(1):21-33. doi: 10.1002/mrdd.20059.
Neuromaturation is the functional development of the central nervous system (CNS). It is by its very nature a dynamic process, a continuous interaction between the genome and first the intrauterine environment, then the extrauterine environment. Understanding neuromaturation and being able to measure it is fundamental to infant neurodevelopmental assessment. Fetal and preterm neuromaturation has become easier to observe with the advent of prenatal ultrasonography and neonatal intensive care units. A number of measures of degree of fetal maturation have been developed and used to estimate gestational age (GA) at birth. The most reliable measures of GA are prenatal measures, especially from the first trimester. Postnatal GA measurements tend to be least accurate at the extremes of gestation, that is, in extremely preterm and post-term infants. Observations of measures of neuromaturation in infants born to mothers with pregnancy complications, including intrauterine growth restriction, multiple gestation, and chronic hypertension, have led to the discovery that stressed pregnancies may accelerate fetal pulmonary and CNS maturation. This acceleration of neuromaturation does not occur before 30 weeks' gestation and has a cost with respect to cognitive limitations manifested in childhood. The ability to measure fetal and preterm neuromaturation provides an assessment of neurodevelopmental progress that can be used to reassure parents or identify at risk infants who would benefit from limited comprehensive follow-up and early intervention services. In addition, measures of neuromaturation have the potential to provide insight into mechanisms of CNS injury and recovery, much-needed early feedback in intervention or treatment trials and a measure of early CNS function for research into the relationships between CNS structure and function.
神经成熟是中枢神经系统（CNS）的功能发育。就其本质而言，它是一个动态过程，是基因组与子宫内环境，然后是子宫外环境之间持续的相互作用。了解神经成熟并能够对其进行测量是婴儿神经发育评估的基础。随着产前超声检查和新生儿重症监护病房的出现，胎儿和早产儿的神经成熟情况变得更容易观察。已经开发出一些胎儿成熟度的测量方法，并用于估计出生时的孕周（GA）。最可靠的孕周测量方法是产前测量，尤其是孕早期的测量。产后孕周测量在孕周极端情况下往往最不准确，即在极早产儿和过期产儿中。对患有妊娠并发症（包括宫内生长受限、多胎妊娠和慢性高血压）的母亲所生婴儿的神经成熟度测量结果的观察发现，应激妊娠可能会加速胎儿肺部和中枢神经系统的成熟。这种神经成熟的加速在妊娠30周之前不会发生，并且在儿童期会表现出认知受限的代价。测量胎儿和早产儿神经成熟度的能力提供了一种神经发育进展评估，可用于安抚父母或识别那些将从有限的全面随访和早期干预服务中受益的高危婴儿。此外，神经成熟度测量有可能深入了解中枢神经系统损伤和恢复的机制，在干预或治疗试验中提供急需的早期反馈，并为研究中枢神经系统结构与功能之间的关系提供早期中枢神经系统功能的测量方法。
