Assessment of Gestational Age

Learning ObjectivesClassify the newborn according to GA.Demonstrate Ballard Dubowitz scale (rating).Apply assessment of GA for newborn.

Classification of newborn by weight and gestational ageHelp in predict potential problemsLBW:

Terms:newbornNeo-natalPre-natalPeri-natalIntra-natal

Assessment of Gestational AgeAn accurate assessment incorporates size and maturity.Assessment methods include:Mothers menstrual historyPrenatal ultrasonographyEvaluation of obstetric parametersPostnatal maturational examinationsDubowitz Assessment of Gestational AgeLubchenco ScaleNew Ballard Score

Infant Classification and Growth AssessmentAfter assessing gestational age, the nurse plots the infants 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)

TermPercentileLarge for gestational age (LGA)Above the 90th percentileAppropriate for gestational age (AGA)Between the tenth and 90th percentilesSmall for gestational age (SGA)Below the tenth percentile

Ballard DubowitzTool 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 precautionHand washingThermal environmentLight and noiseLess than 5minutes examination time

GESTATIONAL AGE ASSESSMENTTwo partsExternal physical characteristicsNeurological characteristicsMaternal conditions, such as pre eclampsia, diabetes, and maternal analgesics and anesthesia may impact certain components of gestational assessment

Neuromuscular MaturityResting PostureSquare windowArm recoilPoplitteal angleScarf signHeel to ear

1. Posture

Clinical assessmentFirst steps and appearanceStart 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 prematurityWell term infant showing typical well flexed postureNote the abduction of the hips in this partially flexed preterm infant (froglike posture)

Well term infant showing typical well flexed postureNote 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 CharacteristicSkinLanugoPlantar creasesAreolaEarGenitalia

Physical Maturity, with maturitySkin: thicker , less translucent, dry, peeling.

Lanugo: fine non pigmented hair all over 27-28 wks disappears graduallyPlantar surface: presence or absence of creases

Physical Maturity, with maturity (cont;)Breast: areola developmentEar cartilageEyelid openingExternal genitaliaRugation, desendProminent labia majora

Intrauterine Growth RateAfter gestational age is determined, it is compared to birth weight to determine if intrauterine growth is appropriateAGA: Appropriate for Gestational Age80% of all birthsSGA: Small for Gestational Age10% of all birthsLGA: Large for Gestational Age10% of all births

Plotting Gestational AgeUpper 90% LGA,

From 10-90 AGA.

Bottom 10% SGA,

Thank You

Application Time