Assessment of Assessment of Gestational AgeGestational 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.

Terms:

newborn

Neo-natal

Pre-natal

Peri-natal

Intra-

natal

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

1. Posture

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)

3. Arm recoil

4.Poplitteal angle

Assessment of Gestational Age: The Dubowitz and Ballard Exams

2. Physical Characteristic

SkinLanugoPlantar creasesAreolaEarGenitalia

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

Plotting Gestational Age

Upper 90% LGA,

From 10-90 AGA.

Bottom 10% SGA,

Thank You …

Application Time