GESTATIONAL AGE

To determine
ASSESSMENT
the approximate gestational
age of a newborn, assess six neuromuscular
and six physical characteristics.
New Ballard Score - appropriate for
newborns from 20 to 44 weeks of gestation,
with the characteristics to assess varying
with the stage of maturity. Each parameter
scores from minus 2 to 5, with the
cumulative score correlating with a
gestational age between 26 and 44 weeks.
Fatima Hyghia Tidal Himpon -- IV(A)

GESTATIONAL AGE
Timing of theASSESSMENT
gestational assessment

influences the accuracy of its results.

< 26 gestational wks - sooner than 12 hours
after birth
26 > gestational wks - within 96 hours of
birth
Overall - best within 48 hours of birth
This assessment information is essential
because gestation relates directly to the
likelihood of complications during the
newborn period.
Lower scores
Fatimacorrelate
Hyghia Tidal Himpon
-- IV(A)prematurity;
with

GESTATIONAL AGE
Components
of Neuromuscular
ASSESSMENT
Assessment
Posture
Square window
Arm recoil
Popliteal angle
Scarf sign
Heel to ear

Perform all assessments with the

newborn lying supine.

Refer to the scoring sheet to base the
specific scores
onTidalyour
for each
Fatima Hyghia
Himpon -- findings
IV(A)

Assess posture

for the degree

of flexion of the
extremities.
Term - legs

and arms :
moderately
flexed at rest
Preterm
newborns lesser degrees
of flexion
Younger the
gestational
age less
flexion
demonstrated
Fatima Hyghia Tidal Himpon -- IV(A)

Assess square window

by grasping the newborns

forearm and gently flexing
the wrist toward the inner
arm. Do not allow rotation
of the wrist.
Measure angle that forms
where the hand meets the
wrist.
Term - hand should touch

the wrist, a 0 angle

Preterm newborns greater angles of flexion
at wrist
Younger the gestational
age flexibility at wrist
Very preterm newborns angle of wrist flexion 5
Fatima Hyghia Tidal Himpon -- IV(A)

Measure arm recoil by

first flexing and holding

both forearms for 5
seconds, then extending
the arms and hands fully
at the newborns side.
Next, release the hands
and allow the arms to
recoil (return to flexion).
Term - full recoil to a

position of flexion
Preterm newborns - less
flexion.

Measure the angle of

flexion at the elbow to

determine the Fatima
armHyghia
recoil
Tidal Himpon -- IV(A)

With the newborns thigh pressed against his

abdomen, measure the popliteal angle by moving

the foot gently toward the head until you meet
resistance.
At this point, measure the angle behind the knee in
the popliteal area.
Term newborns - less flexible (90 )
Very preterm newborns - leg straightens to a 180

Fatima Hyghia Tidal Himpon -- IV(A)

Assess the scarf

sign by grasping
the newborns hand
and attempting to
cross the arm over
his body at the
neck.
arms of term

newborns resistance before

crossing midline
preterm newborns cross the elbow past
midline.
Fatima Hyghia Tidal Himpon -- IV(A)

Assess heel to ear by raising the newborns heel

toward his head in an attempt to bring the foot to the

ear.
Do not raise the newborns buttocks off of the
examination surface.
Stop when you meet resistance and measure the
degree of extension of the leg.
preterm newborns
- youll
come
close to touching the heel 9to
Fatima Hyghia
Tidal Himpon
-- IV(A)

GESTATIONAL AGE
ASSESSMENT
The components of the physical maturity

assessment
Skin
Lanugo
plantar surface
Breast
eye/ear
Genitals

Base your scores for these parameters on

your assessment findings.

Fatima Hyghia Tidal Himpon -- IV(A)

10

The skin ranges from

translucent and friable in

preterm newborns to leathery,
cracked, and wrinkled in postterm newborns. Assess the skin
for transparency, cracks, veins,
peeling, and wrinkles.
Lanugo is very fine body hair.

Extremely premature newborns

have none. During the middle
of the third trimester, most
fetuses have plentiful lanugo.
Closer to term - begins to thin
Terms newborns -very little
Post-term newborns
nearly
Fatima Hyghia- Tidal
Himpon -- IV(A)

11

Inspect the plantar

surface of the foot for

creases.
Term newborns - creases over

the entire plantar surface

Preterm newborn - from absent
to faint red markings

Inspect the breast to

assess the size of the breast

bud in millimeters and the
development of the areola.
Term newborns - raised to a full

areola with breast buds that

are 3 to 10 millimeters in
diameter
Preterm newborns lack
Fatima Hyghia Tidal Himpon -- IV(A)
developed breast tissue 12

The eye/ear assessment is

an analysis of the ear

cartilage and shape of the
pinna.
Pinna:
less curved in preterm

newborns
term newborns have a wellcurved pinna with firm
cartilage

Determine ear recoil by

folding the pinna down and

assessing how quickly it
returns to its previous
position.
Very preterm newborns may

have fused eyelids.

Youll score the degree of

Fatima Hyghia Tidal Himpon -- IV(A)
fusion for these newborns.

13

Observe genitals for physical maturity.

Males: the testes usually descend near term and rugae

(ridges or folds) are visible on the scrotum. Palpate the testes

to determine if they have descended and note the rugae
Extreme prematurity - scrotum is flat and smooth.

Female:
Term - labia majora larger than clitoris and the labia minora
Preterm - prominent clitoris; small labia minora

Base your scores on the degree of development of the labia.

Fatima Hyghia Tidal Himpon -- IV(A)

14