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WEEK OF GESTATION

CM.

53

52

51

5049

48

47

46

45

44

43

42

41

40

39

38

3736

35

34

33

32

31

30

0

GM.

2400

2200

2000

1800

1600

1400

1200

1000

800

600

400

0

GM.

4000

3800

3600

3400

3200

3000

2800

2600

90%

75%

50%

25%

10%

WEIGHT______ gm

LENGTH______ cm

PRE-TERM TERM POST-TERM

90%

75%

50%

25%

10%

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

WEEK OF GESTATION

CM.

42

41

40

3938

37

36

35

34

33

32

31

30

29

28

27

2625

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

INTRAUTERINE WEIGHT-LENGTH RATIO

100 w GRAMS/L3 CENTIM ETERS

BOTH SEXES

HEAD CIRCUM-

FERENCE______ cm

9

7

5

2

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

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

WEEK OF GESTATION

7

5

2

1

9

CLASSIFICATION OF NEWBORNS -BASED ON MATURITY AND INTRAUTERINE GROWTH

Symbols: X - 1st Exam O - 2nd Exam

1st Exam (X) 2nd Exam (O)

LARGE FOR GESTATIONAL AGE (LGA)

APPROPRIATE FOR GESTATIONAL AGE (AGA)

SMALL FOR GESTATIONAL AGE (SGA)

Age at Exam hrs hrs

Signature of Examiner M.D./R.N. M.D./R.N.

LB146 REV 6/04  ©1988, 1992, 1997, 1999 Mead Johnson & Company, Evansville, Indiana 47721 U.S.A.

Adapted from Lubchenco LO, Hansman C, and Boyd E: Pediatr.

 1966;37:403; Battaglia FC, and Lubchenco LO:J Pediatr.

 1967;71:159.

Sid

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NEWBORN MATURITY RATING & CLASSIFICATION

ESTIMATION OF GESTATIONAL AGE BY MATURITY RATINGSymbols: X - 1st Exam O - 2nd Exam

Side

Gestation by Dates ______________________wks

am

Birth Date ______________Hour __________ pm

APGAR________________1 min _________5 min

MATURITY RATING

score weeks

-10 20

-5 22

0 24

5 26

10 2815 30

20 32

25 34

30 36

35 38

40 40

45 42

50 44

SCORING SECTION

1st Exam=X 2nd Exam=O

EstimatingGest Age

by MaturityRating ________Weeks _________Weeks

Time of Date__________ Date __________ Exam am am

Hour _______pm Hour________pm

Age at

Exam _________Hours _________Hours

Signature ______________ ______________ of

Examiner ______________ ______________ M.D./R.N. M.D./R.N.

PHYSICAL MATURITY

superficial parchment;sticky; gelatinous; smooth; peeling cracking; deep leathery;

Skin friable; red; pink; &/or rash; pale areas; cracking; cracked;transparent translucent visible veins few veins rare veins no vessels wrinkled

bald mostlyLanugo none sparse abundant thinning areas bald

heel-toe >50 mm; faint anterior creasesPlantar 40-50 mm: -1 no red transverse creases overSurface <40 mm: -2 crease marks crease only ant. 2/3 entire sole

stippled raised ful l areola;Breast imperceptib le bare ly flat areola; areo la ; areola; 5 -10 mm

percept ible no bud 1-2 mm bud 3-4 mm bud bud

well-curved formedlids fused lids open; sl. curved pinna; & firm; thick

Eye/Ear loosely: -1 pinna flat ; pinna; sof t; soft but instant carti lage;tightly: -2 stays folded slow recoil ready recoil recoil ear stiff

scrotum scrotum testes in testes testes testesGenitals flat; empty; upper canal; descending; down; pendulous;

male smooth faint rugae rare rugae few rugae good rugae deep rugae

prominent prominent majora majora majora

Genitals clitoris clitoris; clitoris; & minora large; coverfemale prominent; small enlarging equally minora clitoris

labia flat labia minora minora prominent small & minora

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.

NEUROMUSCULAR MATURITY

-1 0 1 2 3 4 5

Posture

SquareWindow(wrist) >90°   90°   60°   45°   30°   0°

Arm Recoil

  180°  140°-180°  110°-140°   90°-110°  <90°

PoplitealAngle

  180°   160°   140°   120°   100°   90°  <90°

Scarf Sign

Heel to Ear

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LB146 REV 11/99

Unified System for Gestational AgeEvaluation 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.

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

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