1. Assessment of Gestational Age

2. Assessment of Gestational AgeBy
Dr. Nahed Said Al- Nagger

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

4. 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.

5. Terms:
Neo-natal
Peri-natal
newborn
Intra-natal
Pre-natal

6. 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

7. 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.

8. Infant Classification and Growth Assessment (Continued)
Term
Percentile
Large 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

9. 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.

10. Examination precaution
Hand washing
Thermal environment
Light and noise
Less than 5minutes examination time

11. GESTATIONAL AGE ASSESSMENT
Two parts
External physical characteristics
Neurological characteristics
Maternal conditions, such as pre eclampsia, diabetes, and maternal analgesics and anesthesia may impact certain components of gestational assessment

12. Neuromuscular Maturity
Resting Posture
Square window
Arm recoil
Poplitteal angle
Scarf sign
Heel to ear

13. 1. Posture

14. Clinical assessment First 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)

15. Well term infant showing typical well flexed posture
Note the abduction of the hips in this partially flexed preterm infant (“froglike” posture)

16. 3. Arm recoil

17. 4.Poplitteal angle

18. Assessment of Gestational Age: The Dubowitz and Ballard Exams

19. 2. Physical Characteristic
Skin
Lanugo
Plantar creases
Areola
Ear
Genitalia

20. Physical Maturity, with maturity
Skin: thicker , less translucent, dry, peeling.
Lanugo:
fine non pigmented hair all over wks
disappears gradually
Plantar surface: presence or absence of creases

21. Physical Maturity, with maturity (cont;)
Breast: areola development
Ear cartilage
Eyelid opening
External genitalia
Rugation, desend
Prominent labia majora

23. 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

25. Plotting Gestational Age
Upper 90% LGA,
From AGA.
Bottom 10% SGA,

26. Thank You …

27. Application Time