Gestational Age Assessment of the Newborn I How to Perform the Gestational Age Assessment Not complete until a gestational age is determined Certain neuromuscular characteristics from the ballard tool can predict within a 2 week lifespan gestational age are charted Ballard Tool shorter and requires less physical things performed on the baby Two parts first part exam of physical and neuromuscular characteristics determines the Once the gestational age is determined the babies weight length and head circumference Babies in the 90th percentile are considered large for their gestational age babies below 10th are considered small for their gestational age babies between are appropriate An infants maturity is not related to its size a 10 pound baby can be premature a 5 pound baby can be full term We can predict certain problems r t gestational age With a preterm baby we can predict they will have issues with organ function respiratory distress most common as lung is one of the last symptoms to mature Post mature baby also predictable and so do babies who are large or small for gestational age time environment Early identification of gestational age allows prompt recognition The physical characteristics are identifiable immediately Physical component is completed first when completing make sure the baby is in warm The skin is assessed for thickness color and presence of superficial veins Look especially on back and shoulder for lanugo last places for lanugo to disappear Look at foot for plantar creases first develop on the anterior portion then go to heel over Breast development 2 components nipple then palpate for presence of breast tissue Amount of cartilage in ear gently pull ear together and release amount of recoil depends measure for areola 5 10mm bud on how much cartilage is developed Male genitalia are assessed for distended of testes and amount of rugae on scrotom Female assessed for prominence of labia majora compared to minora and clit Now neuromuscular component of the exam desirable for newborn to be in calm quiet environment maybe 1 hr after birth If the infant is not awake or depressed encouraged to repeat the exam after 24 hrs of age First criteria is posture note degree of flexion in elbows hips and knees Flex hand onto forearm look at angle the square window reflects joint mobility 0 To evaluate arm recoil flex and hold arms for 5 seconds and then pull them back and see degree angle is the best how they recoil 90 degree angle best degree of knee determines the score Popliteal ankle thigh flexed on abdomen while leg is extended till resistance is met Scarf sign wrapped around babies neck to score determine location of elbow The heel to ear extension similar to popliteal the hip stays in contact with bed but you pull the foot until resistance is met to score look at the angle of knee Physical total 21 neuromuscular 22 43 maturity rating table corresponds to 41 weeks gestation accuracy has a 2 week range Then compare babies weight length head circumference to other babies at that age Baby who is SGA in weight and length but normal head circumference treat baby as sga baby this is done to predict problems the baby may experience Some Variations II Lanugo is the thickest between 28 30 weeks and gradually disappears till at term and at least half the baby is bald look for it at back and shoulder Assess sole creases before 12 hours of age bc superficial cracking can interfere Premature nipple is barely visible and no palpable tissue Term infant can see areola tissue more than 1 cm of palpable breast tissue Ear stays folded means lack of cartilage and recoil is slow 34 40 weeks gestation cartilage forms and recoil of the ear Before 36 weeks the labia minora are prominent and the labia majora is not prominent by 40 weeks should cover clit and labia minora 34 weeks more flexion in upper extension knees are more tightly flexed Premature babies never develop the 0 degree square window Popliteal s less than 90 degrees is good more resistance Preterm foot comes closer to the head no resistance want it to be less than 90 degrees III Post Test 3600 gm 50 cm 35 cm