CLASSIFICATION OF NEWBORNS BASED ON MATURITY AND INTRAUTERINE GROWTH Symbols: X - 1st Exam O - 2nd Exam WEEK OF GESTATION

CM. 53 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 0 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 90% CM. 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 0 3.60 3.50 3.40 3.30 3.20 3.10 3.00 2.90 2.80 2.70 2.60 2.50 2.40 2.30 2.20 2.10 2.00 1.90 1.80 1.70 1.60 0

Side 2

WEEK OF GESTATION
24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43

LENGTH______ cm

75% 50% 25% 10%

HEAD CIRCUMFERENCE______ cm
90% 75% 50% 25% 10%

90%

WEIGHT______ gm

75% 50% 25%

GM. 2400 2200 2000 1800 1600 1400 1200 1000 800 600 400 0

10%

GM. 4000 3800 3600 3400 3200 3000 2800 2600

INTRAUTERINE WEIGHT-LENGTH RATIO 100 w GRAMS/L3 CENTIMETERS BOTH SEXES

90% 75% 50% 25% 10%

PRE-TERM

TERM

POST-TERM

24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43

WEEK OF GESTATION
1st Exam (X) LARGE FOR GESTATIONAL AGE (LGA) APPROPRIATE FOR GESTATIONAL AGE (AGA) SMALL FOR GESTATIONAL AGE (SGA) Age at Exam Signature of Examiner hrs M.D./R.N. hrs M.D./R.N. 2nd Exam (O)

Adapted from Lubchenco LO, Hansman C, and Boyd E: Pediatr. 1966;37:403; Battaglia FC, and Lubchenco LO: J Pediatr. 1967;71:159.

LB146 REV 6/04

1988, 1992, 1997, 1999 Mead Johnson & Company, Evansville, Indiana 47721 U.S.A.

NEWBORN MATURITY RATING & CLASSIFICATION

ESTIMATION OF GESTATIONAL AGE BY MATURITY RATING Symbols: X - 1st Exam O - 2nd Exam
Side 1

Gestation by Dates ______________________wks

NEUROMUSCULAR MATURITY
-1 Posture 0 1 2 3 4 5

am Birth Date ______________Hour __________ pm APGAR ________________1 min _________5 min

Square Window (wrist) Arm Recoil

MATURITY RATING
>90 90 60 45 30 0

180 140-180 110-140 Popliteal Angle 180 Scarf Sign 160 140 120

90-110

<90

100

90

<90

Heel to Ear

PHYSICAL MATURITY
Skin sticky; friable; transparent gelatinous; red; translucent smooth; pink; visible veins superficial peeling &/or rash; few veins cracking; pale areas; rare veins bald areas parchment; deep cracking; no vessels mostly bald creases over entire sole full areola; 5-10 mm bud thick cartilage; ear stiff testes pendulous; deep rugae majora cover clitoris & minora leathery; cracked; wrinkled

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

SCORING SECTION
1st Exam=X
Estimating Gest Age by Maturity Rating Time of Exam

Lanugo

none heel-toe 40-50 mm: -1 <40 mm: -2 imperceptible

sparse >50 mm; no crease barely perceptible lids open; pinna flat; stays folded scrotum empty; faint rugae prominent clitoris; small labia minora

abundant faint red marks flat areola; no bud sl. curved pinna; soft; slow recoil

thinning anterior transverse crease only

2nd Exam=O

Plantar Surface Breast

creases ant. 2/3

stippled raised areola; areola; 1-2 mm bud 3-4 mm bud well-curved pinna; soft but ready recoil formed & firm; instant recoil testes down; good rugae majora large; minora small

________Weeks _________Weeks Date __________ Date __________ am am Hour _______pm Hour________pm

Eye/Ear

lids fused loosely: -1 tightly: -2 scrotum flat; smooth clitoris prominent; labia flat

Genitals male Genitals female

testes in testes upper canal; descending; rare rugae few rugae prominent clitoris; enlarging minora majora & minora equally prominent

Age at Exam

_________Hours

_________Hours

Scoring system: Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr. 1991;119:417-423.

Signature of Examiner

______________ ______________
M.D./R.N.

______________ ______________
M.D./R.N.

Provided Courtesy of

Unified System for Gestational Age Evaluation and Classification of the Newborn
Accurate estimation of gestational age and the evaluation of the appropriateness of fetal growth are vital in the care of newborns. A unified system has been developed which enables the physician and other health care professionals to rapidly yet accurately classify all newborns and identify the high-risk neonate. The form consists of two complementary evaluations(1) gestational age in weeks based upon selected neurologic and physical characteristics; and (2) fetal growth (weight, length, and head circumference) compared to normal standards. By these evaluations, neonates can be categorized as appropriate-for-gestational age (AGA), small-for-gestational age (SGA), and large-for-gestational age (LGA). In addition, they can also be identified as pre-term (less than 37 weeks' gestation, term (37 to 42 weeks' gestation) or post-term (greater than 42 weeks' gestation). To ensure accuracy, the procedure should be followed as outlined. This record should be placed with the newborn's permanent record.

Developed by Jacob L. Kay, M.D., Seton Medical Center, Austin, Texas; in conjunction with Mead Johnson Nutritionals, Evansville, Indiana.

Provided Courtesy of

LB146 REV 11/99

1988, 1992, 1997 Mead Johnson & Company, Evansville, IN 47721 U.S.A.