General Observation

Using careful observational skills, the examiner can obtain much useful information without even touching the infant.

One can assess the infant's skin color, respiratory effort, and

NEUROMUSCULAR MATURITY

-1

0

1

2

3

4

5

Posture

<£C

GH:

Square Window (wrist)

>90°

90°

60°

45°

30°

Arm Recoil

180°

140°-180°

110°-140°

îc)0

<90°

Popliteal Angle

180°

160°

140°

120°

100°

90°

<90°

Scarf Sign

4

4

4

4

4

Heel to Ear

cts*

c£s

PHYSICAL MATURITY

Skin

sticky; friable; transparent

gelatinous;

red; translucent

smooth; pink; visible veins

superficial peeling and/or rash; few veins

cracking; pale areas; rare veins

parchment;

deep cracking; no vessels

leathery; cracked; wrinkled

Lanugo

none

sparse

abundant

thinning

bald areas

mostly bald

Plantar surface

heel-toe 40-50 mm: -1 <40 mm: -2

no crease

faint red marks

anterior transverse crease only

creases ant. 2/3

creases over entire sole

Breast

imperceptible

barely perceptible

flat areola; no bud

stippled areola; 1-2 mm bud

raised areola; 3-4 mm bud

full areola; 5-10 mm bud

Eye/ear

lids fused loosely: -1 tightly: -2

lids open; pinna flat; stays folded

sl. curved pinna; soft; slow recoil

well-curved pinna; soft but ready recoil

formed & firm; instant recoil

thick cartilage; ear stuff

Genitals male

scrotum flat; smooth

scrotum empty; faint rugae

testes in upper canal; rare rugae

testes descending; few rugae

testes down; good rugae

testes pendulous; deep rugae

Genitals female

clitoris prominent; labia flat

prominent clitoris; small labia minora

prominent clitoris; enlarging minora

majora & minora equally prominent

majora large; minora small

majora cover clitoris & minora

Figure 22-3 Maturational assessment of gestational age (new Ballard score). See Box 22-4 for a description of the technique. (From BallardJL, KhouryJC, Wedig K

et al: New Ballard score, expanded to include extremely premature infants. J Pediatr 1991;119:417-423.)

MATURITY RATING

Score

Weeks

-10

20

-5

22

0

24

5

26

10

28

15

30

20

32

25

34

30

36

35

38

40

40

45

42

50

44

Figure 22-3 Maturational assessment of gestational age (new Ballard score). See Box 22-4 for a description of the technique. (From BallardJL, KhouryJC, Wedig K

et al: New Ballard score, expanded to include extremely premature infants. J Pediatr 1991;119:417-423.)

activity state; the muscle tone can be assessed by observing whether the infant lies in a flexed position and spontaneously moves the extremities.

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