Assessment of Gestational Age Assessment of Gestational Age.
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Transcript of Assessment of Gestational Age Assessment of Gestational Age.
Learning Objectives• Classify the newborn according to
GA.• Demonstrate Ballard Dubowitz
scale (rating).• Apply assessment of GA for
newborn.
Classification of newborn by weight and gestational
age• Help in predict potential problems
–LBW: <2500gm–VLBW: <1500gm–ELBW: <1000gm.
– Term :completed 37 weeks gestation till 42 week
– Premature; less than 37 weeks gestation
– Post term: after 42 weeks.
Assessment of Gestational Age
• An accurate assessment incorporates size and maturity.
• Assessment methods include:– Mother’s menstrual history– Prenatal ultrasonography– Evaluation of obstetric parameters– Postnatal maturational examinations
•Dubowitz Assessment of Gestational Age•Lubchenco Scale•New Ballard Score
Infant Classification and Growth Assessment
• After assessing gestational age, the nurse plots the infant’s length, weight and occipital-frontal head circumference (OFC) on intrauterine growth charts.
• Growth curves show measures of intrauterine growth in percentiles for each week of gestation.
Infant Classification and Growth
Assessment (Continued)
Term PercentileLarge for gestational age (LGA)
Above the 90th percentile
Appropriate for gestational age (AGA)
Between the tenth and 90th percentiles
Small for gestational age (SGA)
Below the tenth percentile
Ballard Dubowitz• Tool to assess gestational age.• Optimal accuracy within 12 hours.• Most accurate 28 wks and under 43 wks.• Physical more accurate than neurological.• GA effected by PIH, DM, meds.
Examination precaution• Hand washing• Thermal environment• Light and noise• Less than 5minutes examination
time
GESTATIONAL AGE ASSESSMENT
•Two parts–External physical characteristics–Neurological characteristicsMaternal conditions, such as pre eclampsia,
diabetes, and maternal analgesics and anesthesia may impact certain components of gestational assessment
Neuromuscular Maturity
•Resting Posture•Square window•Arm recoil•Poplitteal angle•Scarf sign•Heel to ear
Clinical assessmentFirst steps and appearance• Start by congratulating the
mother on the arrival of her new baby and ask if she has any concerns. The mother is usually the first person to notice any problems.
• Ask about feeding and the passage of urine and stools. The infant should pass meconium (the first black, tarry stools) within 24 hours of birth.
• General observation: inspect colour, breathing, alertness and spontaneous activity.
• Well infants have a flexed, posture. Partially flexed posture is found in hypotonia or prematurity
Well term infant showing typical well flexed posture
Note the abduction of the hips in this partially flexed preterm infant (“froglike”
posture)
Well term infant showing typical well flexed posture
Note the abduction of the hips in this partially flexed preterm infant (“froglike” posture)
Physical Maturity, with maturity
• Skin: thicker , less translucent, dry, peeling.
• Lanugo: – fine non pigmented hair all over 27-28 wks– disappears gradually
• Plantar surface: presence or absence of creases
Physical Maturity, with maturity (cont;)
• Breast: areola development• Ear cartilage• Eyelid opening• External genitalia
– Rugation, desend– Prominent labia majora
Intrauterine Growth Rate
• After gestational age is determined, it is compared to birth weight to determine if intrauterine growth is appropriate
• AGA: Appropriate for Gestational Age– 80% of all births
• SGA: Small for Gestational Age– 10% of all births
• LGA: Large for Gestational Age– 10% of all births