Revisiting KANET in the context of fetal connectomics: defining optimal gestational windows for neurodevelopmental screening.

Journal: Journal of perinatal medicine
Published Date: Nov 26, 2025

Abstract

OBJECTIVES: To introduce the KANET-connectome matrix (KANET-Con) as a conceptual framework linking fetal behaviors observed on four-dimensional (4D) ultrasound to underlying neural network maturation, and to evaluate optimal gestational timing for functional neurodevelopmental screening. METHODS: A narrative review was conducted using a PRISMA-guided literature identification and screening process. PubMed, Scopus, and Web of Science were searched (January 2000-March 2025) for studies addressing fetal connectomics, fetal neurobehavior, KANET scoring, and developmental neuroimaging. Forty-two peer-reviewed studies met inclusion criteria. Observed fetal behaviors-including facial mimicry, eye blinking, limb movement, and overall gestalt coordination-were aligned with their most plausible neural substrates using evidence from developmental neuroscience and imaging. RESULTS: Findings demonstrated clear temporal associations between specific fetal behaviors and neural circuit development. Eye blinking and facial expressions (24-26 weeks) correlated with brainstem-cortical integration; hand-to-face gestures (26-30 weeks) reflected emerging interhemispheric pathways; and complex limb coordination (28-32 weeks) was linked to corticospinal and basal ganglia maturation. Collectively, these data indicate that 24-32 weeks of gestation represents an optimal window for KANET-based neurobehavioral screening. Additionally, emerging artificial intelligence applications show potential to enhance scoring objectivity by detecting subtle movement features such as behavioral entropy, asymmetry, and latency. CONCLUSIONS: KANET, interpreted through a fetal connectomic lens, provides a functional window into early neural integration. The KANET-Con offers a clinically relevant, globally accessible conceptual model to support early detection of neurodevelopmental deviations and inform risk stratification, particularly in resource-limited settings.

Authors

  • Wiku Andonotopo
    Fetomaternal Division, Department of Obstetrics and Gynecology, Ekahospital BSD City, Serpong, Tangerang, Banten, Indonesia.
  • Muhammad Adrianes Bachnas
    Fetomaternal Division, Department of Obstetrics and Gynecology, Medical Faculty of Sebelas Maret University, Moewardi Hospital, Solo, Surakarta, Indonesia.
  • Julian Dewantiningrum
    Fetomaternal Division, Department of Obstetrics and Gynecology, Medical Faculty of Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia.
  • Mochammad Besari Adi Pramono
    Fetomaternal Division, Department of Obstetrics and Gynecology, Medical Faculty of Diponegoro University, Dr. Kariadi Hospital, Semarang, Indonesia.
  • I Nyoman Hariyasa Sanjaya
    Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Faculty of Medicine Universitas Udayana, Prof. dr. I.G.N.G Ngoerah General Hospital, Denpasar, Bali, Indonesia.
  • Ernawati Darmawan
    Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia.
  • Muhammad Ilham Aldika Akbar
    Department of Obstetrics and Gynecology, Universitas Airlangga Hospital - Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
  • Dudy Aldiansyah
    Fetomaternal Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, H. Adam Malik General Hospital, Medan, Sumatera Utara, Indonesia.
  • Cut Meurah Yeni
    Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Syiah Kuala, Dr. Zainoel Abidin General Hospital, Aceh, Indonesia.
  • Nuswil Bernolian
    Department of Obstetrics and Gynecology, Fetomaternal Division, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.
  • Sri Sulistyowati
    Department of Obstetrics and Gynecology, Faculty of Medicine, Maternal-Fetal Medicine Division, Sebelas Maret University, Sebelas Maret University Hospital, Solo, Indonesia.
  • Waskita Ekamaheswara Kasumba Andanaputra
    Department of Medicine, Undergraduate Program in Medical Science, Faculty of Medicine, Padjajaran University, Bandung, West Java, Indonesia.
  • Milan Stanojevic
    Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia.
  • Asim Kurjak
    Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia.

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