General Assessment

After the Apgar score has been determined, the gestational age should be assessed. Because gestational age based on menstrual dates is frequently inaccurate, it is important to make an objective determination of the gestational age, which is an indicator of the maturity of the newborn. Gestational age has important implications for the challenges of adaptation the infant will face in the coming hours and days. Experienced clinicians can make a fairly accurate assessment of gestational age in the delivery room. A more formal assessment is then performed in the nursery; it should be done in the first 24 hours after the infant's birth. The standardized system for assessing gestational age is the Ballard Clinical Assessment. This is based on 10 neurologic signs and 11 external signs such as skin texture, breast size, and genital development. The neurologic scoring system is shown in Figure 24-3, and the external criteria are shown in Table 24-3.

The total scores of the neurologic and external signs are summed. The sum is then correlated with the gestational age, according to the graph shown in Figure 24-4. A sum between 46 and 60 is associated with a gestational age of 37 to 41 weeks. A child with a gestational age from 37 to 41 weeks is denoted a term infant, although some authorities believe that a gestational age of

*Passage of a small catheter through the external nares to the pharynx, which is done to determine ''reflex irritability,'' can also determine patency of the internal nasal choanae. See later discussion under ''Nose.''

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