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A new scoring system for the assessment of neurological status for antenatal application is proposed, similar to the neonatal optimality test of Amiel-Tison. This preliminary work may help in detecting fetal brain and neurodevelopmental alterations due to in utero brain impairment.

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The Amiel-Tison Neurological Assessment at Term (ATNAT) is part of a set of three different instruments based on a neuro-maturative framework. By sharing a same methodology and a similar scoring system, the use of these three assessments prevents any rupture in the course of high risk children follow-up from 32 weeks post-conception to 6 years of age. The ATNAT which takes 5 minutes to administer may be used in clinical setting as well as in research. Clustering of severe to mild neuro-cranial signs in the neonatal period permits identification of children who could benefit from early intervention.

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This article reviews the interpretation of the fetal motor repertoire in the light of neurophysiology and clinical neurology. The continuity of the maturative process from the fetus to the neonate allows us to speculate on the predictive value of optimal and non-optimal neurological function as observed in the fetus and their morphological consequences. Neonatologists know that early prediction concerning outcome is reliable only at the two ends of the spectrum, e.g., optimal and very abnormal situations. However, in intermediate situations the quality of observations achieved by 3D-4D ultrasonography already allows to demonstrate the prenatal onset of brain damage, based on morphologic and functional signs. Their identification during the second half of pregnancy may serve as a retrospective marker of a prenatal insult.