This document provides definitions and classifications related to newborn assessment. It defines terms like neonate, gestational age, preterm, term, etc. It describes how newborns can be classified based on gestational age, birth weight, and weight for gestational age. The document also discusses methods for assessing gestational age both antenatally using clinical, biochemical and radiological methods, and after birth using physical and neurological examination criteria like the Ballard Score. The Ballard Score involves assessing 12 physical and neurological criteria to determine gestational age.
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
Gestational age is a key piece of data used by healthcare providers to determine the timing of various screening tests and assessments of the fetus and mother throughout pregnancy. Gestational age may be assessed at any time during pregnancy, and several modes of assessment exist, each requiring different equipment or skills and with varying degrees of accuracy. Obtaining more accurate estimates of gestational age through better diagnostic approaches may initiate more prompt medical management of a pregnant patient.
This presentation is aimed at giving the basic information of a neonate classification on basis of gestational age and the birth weight. Prematurity has been discussed in details. I have also included the growth charts that can be used for growth monitoring in term as well as preterm babies.
** This presentation is available in a video lecture format at my youtube channel - NeonatoHub. Do watch it for further understanding of the topic & subscribe to the channel.
Maternal and Neonatal morbidity and MortalityBPKIHS
It deals with:
Introduction
International Perspectives
National Status
Complication during Pregnancy, Childbirth, Postpartum period including Neonatal Problems
Causes of Maternal and neonatal mortality
Framework of determinants of maternal mortality
Three delay model
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
Gestational age is a key piece of data used by healthcare providers to determine the timing of various screening tests and assessments of the fetus and mother throughout pregnancy. Gestational age may be assessed at any time during pregnancy, and several modes of assessment exist, each requiring different equipment or skills and with varying degrees of accuracy. Obtaining more accurate estimates of gestational age through better diagnostic approaches may initiate more prompt medical management of a pregnant patient.
This presentation is aimed at giving the basic information of a neonate classification on basis of gestational age and the birth weight. Prematurity has been discussed in details. I have also included the growth charts that can be used for growth monitoring in term as well as preterm babies.
** This presentation is available in a video lecture format at my youtube channel - NeonatoHub. Do watch it for further understanding of the topic & subscribe to the channel.
Maternal and Neonatal morbidity and MortalityBPKIHS
It deals with:
Introduction
International Perspectives
National Status
Complication during Pregnancy, Childbirth, Postpartum period including Neonatal Problems
Causes of Maternal and neonatal mortality
Framework of determinants of maternal mortality
Three delay model
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
Fetal skull is to some extent compressible and made mainly of thin pliable tabular (flat) bones forming
the vault. This is anchored to the rigid and incompressible bones at the base of the skull.
Introduction of Newborn
Definition of newborn:
A baby from birth to 28 days of age is called newborn.
Classification of newborn:
According to gestation and birth weight newborn are classified as follows:
1. Gestation:
Preterm : < 37 completed weeks of gestation
Term : 37 to 42 weeks
Post -term : > 42 completed weeks
2. Birth Weight:
Normal birth weight : 2500 g – 4000g
Low birth weight : < 2500g
Very low birth weight : < 1500g
Extreme low birth weight : < 1000g
3. Birth Weight & Gestation:
Appropriate for Gestational Age (AGA) : Birth weight between 10th & 90 the centiles for
the particular gestational age
Small for Gestational Age (SGA) : Birth weight <10th>90 the centiles for
the particular gestational age
Criteria of a normal term newborn infant:
A normal newborn has all of the following features:
1. Gestation : 37 to 42 completed weeks
2. Birth weight: Between 2500g & 4000g.
3. Breathing: Spontaneous, regular & rate between 30- 60 per minute.
4. Colour : Pink but slight peripheral cyanosis soon after birth is normal.
5. Heart rate: 100-160 beats per minute.
6. Axillary temperature: 97.5 -99˚F
7. Normal baby should be able to suck after birth.
8. Most babies pass urine within 24 hours of birth but some babies may not pass urine up to 48 hours of birth.
9. Most babies will pass meconium within 24 hours a day.
10. A newborn baby sleeps baby sleeps around 18 hours a day.
11. No apparent congenital malformation.
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
Fetal skull is to some extent compressible and made mainly of thin pliable tabular (flat) bones forming
the vault. This is anchored to the rigid and incompressible bones at the base of the skull.
Introduction of Newborn
Definition of newborn:
A baby from birth to 28 days of age is called newborn.
Classification of newborn:
According to gestation and birth weight newborn are classified as follows:
1. Gestation:
Preterm : < 37 completed weeks of gestation
Term : 37 to 42 weeks
Post -term : > 42 completed weeks
2. Birth Weight:
Normal birth weight : 2500 g – 4000g
Low birth weight : < 2500g
Very low birth weight : < 1500g
Extreme low birth weight : < 1000g
3. Birth Weight & Gestation:
Appropriate for Gestational Age (AGA) : Birth weight between 10th & 90 the centiles for
the particular gestational age
Small for Gestational Age (SGA) : Birth weight <10th>90 the centiles for
the particular gestational age
Criteria of a normal term newborn infant:
A normal newborn has all of the following features:
1. Gestation : 37 to 42 completed weeks
2. Birth weight: Between 2500g & 4000g.
3. Breathing: Spontaneous, regular & rate between 30- 60 per minute.
4. Colour : Pink but slight peripheral cyanosis soon after birth is normal.
5. Heart rate: 100-160 beats per minute.
6. Axillary temperature: 97.5 -99˚F
7. Normal baby should be able to suck after birth.
8. Most babies pass urine within 24 hours of birth but some babies may not pass urine up to 48 hours of birth.
9. Most babies will pass meconium within 24 hours a day.
10. A newborn baby sleeps baby sleeps around 18 hours a day.
11. No apparent congenital malformation.
Raynaud's disease, also known as Raynaud's phenomenon or Raynaud's syndrome, is a condition that affects blood flow to certain parts of the body—usually the fingers and toes. In Raynaud's disease, smaller arteries that supply blood to the skin constrict excessively in response to cold or stress, limiting blood supply to affected areas (vasospasm). This can lead to numbness, tingling, and color changes in the affected areas, typically turning them white or blue.
Prenatal Assessment of Gestational Age - Case Presentation Nawras AlHalabi
Prenatal Assessment of Gestational Age - Case Presentation
تقدير عمل الحمل، حالة سريرية.
Faculty of Medicine of Syrian Private University
كليّة الطّبّ البشريّ في الجامعة السّوريّة الخاصّة
20-12-2015
Neonatal Gestational Age Assessment.pptssuser1bd71a
The Ballard scale (BS) is a set of procedures developed by Dr.Jeanne L Ballard, to determine Gestational Age through neuromuscular and External physical assessment of a newborn
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
How to Give Better Lectures: Some Tips for Doctors
Assessment of Gestational age
1.
2. DEFINITIONS
• NEONATE/NEWBORN: birth to 4 weeks
• EARLY NEONATAL PERIOD: first 7 days
• LATE NEONATAL PERIOD: 7th to <28th day
• NEWLY BORN: first minutes to few hours
• STILLBIRTH: fetal death at a GA of 22 weeks or
more or weighing more than 500 grams
• PERINATAL PERIOD: 22 weeks of gestation to
7 completed days after birth
3. DEFINITIONS
• Gestational age (completed weeks): time
elapsed between the first day of the last
menstrual period and the day of delivery.
• Postnatal (chronological) age (days, weeks,
months or years): age since birth
• Postmenstrual age (weeks): Gestational age plus
chronological age
• Corrected age (weeks or months): chronological
age reduced by the number of weeks born before
40 weeks of gestation. This term should be used
only for children upto 3 years of age who were
born preterm
5. Classification by Gestational Age
• PRETERM: less than 37 weeks of gestation (259 days)
< 32 weeks : VERY PRETERM births
320/7 and 336/7 weeks: MODERATE PRETERM
340/7 and 366/7 weeks: LATE PRETERM births
‘NEAR TERM’ is no longer used to refer to the third group
(Late preterm), because the phrase falsely conveys a
message that such “borderline” preterm infants are almost
as mature as term infants
• TERM: completed 37-416/7 weeks of gestation (260-294
days)
• POST-TERM: 42 weeks of gestation or more (295 days)
6. • WHO defines PRETERM BIRTH as a birth
occurying either before 37 COMPLETED weeks of
gestation OR on or before the 259th day, counting
from the first day of LMP.
• ONLY completed weeks of gestation are reported.
Therefore an infant born 6 days after completing
35 weeks of gestation is noted as 35 weeks, not
rounded upto 36 weeks (356/7weeks)
7. Classification by Birth Weight
• MACROSOMIA: more than 4000 grams
• NORMAL: between 2500 - 4000 grams
• LBW: birth weight less than 2500 grams,
more than 1500 grams
• VLBW: birth weight less than 1500 grams,
more than 1000 grams
• ELBW: birth weight less than 1000 grams
8.
9. Classification by Weight for
Gestational Age
• AGA: birth weight between 10th and 90th
centile for gestational age
• SGA: birth weight below 10th centile for
gestational age
• LGA: birth weight greater than 90th centile for
gestational age
10.
11. SGA vs IUGR
• SGA and IUGR are not synonymous
• SGA describes a neonate whose birth weight or
birth crown-heel length is <10th percentile for GA
or <2 SD below the mean for the infants GA
• IUGR describes diminished growth velocity in the
fetus as documented by atleast 2 intrauterine
growth assessments
• All IUGR babies can be SGA but,
not all SGA babies are IUGR
12. ASSESSMENT OF GESTATIONAL AGE
• The first aim is to establish if the baby is term
or preterm
• The next aim should be to assess the exact
gestational age in weeks of completed
gestation
• For classification of babies on the basis of
birth weight and gestational age, it is
mandatory that accurate gestational age of
the baby should be known.
13. GESTATIONAL AGE ASSESSMENT
Antenatal assessment of gestational age
• Clinical
• Biochemical
• Cytological
• Radiological
Assessment of gestation after birth
• Physical and Neurological characteristics/criteria
14. Antenatal assessment of
gestational age - CLINICAL
• EDD is calculated by adding 9 months and 7 days to the
1st day of mother’s LMP (NAEGELE’S RULE) – reliable
only if the menstrual cycles are regular and unmodified
by oral contraceptives or maternal diseases, and the
last menstrual period has been normal for flow and
duration
• Height of the uterine fundus during early pregnancy –
16weeks: just above pubic symphysis
• Date of quickening: 18th week
• Appearance of fetal heart sounds: 16-18 weeks
• Fetal form and femur length by ultrasonic techniques
• Maternal weight gain
15. Antenatal assessment of
gestational age - BIOCHEMICAL
• Organic constituents in the liquor amnii, creatinine and
urea progressively rise with advancing maturity while
protein, glucose, lactic and pyruvic acids progressively
decline
• Rise in creatinine is due to increasing muscle mass as
the baby grows and would under-estimate the maturity
of small for dates babies.
• Amniotic fluid creatinine level of >2mg/dl is associated
with gestational maturity of atleast 36 weeks
• Lecithin/Spingomyelin ratio of >2 is indicative of
satisfactory lung maturity, except in mothers with
diabetes mellitus
16. Antenatal assessment of
gestational age - CYTOLOGICAL
• Vaginal wall cytology shows the presence of more
superficial cells as term approaches
• Amniotic fluid cytology for organophilic squame cells,
which are stained orange with Nile blue sulfate, is a
reliable method for prenatal assessment of gestation.
These anucleated orange staining cells derived from
sebaceous glands of the fetus,
a) Increase after 38 weeks of gestation
b) 32-37 weeks: about 10% of amniotic cells show these
characteristics
c) Before 30 weeks: practically no such cells are seen
17. Antenatal assessment of
gestational age - RADIOLOGICAL
• The ossification centers at the lower femoral
and upper tibial epiphyses appear at 36 weeks
and 38 weeks respectively
• Intrauterine growth retardation and cretinism
delay the ossification
• The absence of an ossification center,
therefore, does not indicate immaturity, but
its presence and size are indicative of maturity
18. Assessment of gestation after birth
• The clinical assessment of gestation at birth by Physical
and Neurological Examination of the baby is MORE
RELIABLE as compared to methods recommended for
assessment of baby in utero
• As gestation proceeds, the baby grows and matures
physically and neurologically.
• Anthropometric measurements- weight, length, HC
and CC are unreliable parameters of maturity because
they may be adversely affected by IUGR
• HC and length are relatively spared in a baby with
intrauterine malnutrition as compared to weight and
CC
19. Physical and Neurological
Characteristics
• These characters together can reliably provide
an estimate of GA after the child is born.
• SCORING SYSTEMS: Dubowitz score and
Ballard score are the 2 most extensively
studied and reported scoring systems for
assessing the GA of a neonate
20. DUBOWITZ SCORE
• Was based on assessment of 22 items (10
neurological signs and 12 external signs)
• It was cumbersome and time consuming
• It was gradually replaced by the Ballard score,
which is easier to perform
21. BALLARD SCORE
• Is based on 6 neurological criteria and 6 physical criteria
• Compared to reliable ultrasound dates, Ballard score tended
to overestimate the GA of preterm infants and underestimate
that of post term infants. It was particularly inaccurate in
ELBW infants, with deviations of over 2 weeks
• Inspite of inaccuracies, most studies were based on Dubowitz
or original Ballard maturation assessments
• To be done within 24 hours of life
• Less reliable after 7 days of age
• In babies with neurological compromise (birth asphyxia), the
composite score cannot be used to determine gestation as it
underestimates the gestation (if hypotonic) and
overestimates, if hypertonic
22. • Further modification of the original Ballard scores
and comparison with dates by ultrasound
produced the NEW BALLARD SCORE (NBS), which
includes ELBW babies.
• This method expands the description of physical
and neurologic features and can be used in
infants from 20 to 44 weeks gestation.
• Correlation is similar when the examination is
performed upto 96 hours of age in infants of
atleast 26 weeks gestation but best if done prior
to 12 hours in infants less than 26 weeks
• NBS has an accuracy of ± 2 weeks
23.
24. NeuromuscularCriteria
– Posture(0to4)
• Observe the infant in an
unrestrained position on
back and estimate the
degree of flexion or
extension of extremities.
• As maturation
progresses, there is
increase in flexion of
extremities
25. NeuromuscularCriteria
– SquareWindow(-1to4)
• Flex the wrist and measure the minimum
angle between the hypothenar eminence and
the ventral surface of forearm
• There is a decrease in angle as maturation
progresses
26. NeuromuscularCriteria
– ArmRecoil(0to4)
• The examiner places one hand
beneath the neonate’s elbow for
support.
• With infant supine and head in
midline, first flex the elbow and
hold the arm against forearm for 5
seconds.
• Then, fully extend the elbow and
release
• Note the time taken to resume
flexed posture
• As gestational age increases, there
is an decrease in angle and rapidity
of recoil increases
27. NeuromuscularCriteria
– PoplitealAngle(-1to5)
• Flex the hips and thighs held
in knee-chest position over
the abdomen
• Without lifting the hips from
the bed surface, support the
side of the thigh with 1 hand
and extend the knee as far as
possible with another hand
• Estimate the popliteal angle
• There is a decrease in angle
as maturation increases
28. NeuromuscularCriteria
– ScarfSign(-1to4)
• The tone of the shoulder
girdle is assessed by taking the
baby’s hand and pulling the
hand to the opposite shoulder
like a scarf
• The thumb of the examiner’s
other hand is placed on the
infant’s elbow
• In a term baby, the hand
should not go past the
shoulder and the elbow
should not cross the midline
of the chest
29. NeuromuscularCriteria
– HeeltoEarManeuver(-1to4)
• Place the infant supine with
pelvis flat on table.
• Grasp one foot with thumb
and index finger and draw foot
as near to ipsilateral ear as
possible.
• The examiner feels for
resistance to extension of the
posterior pelvic girdle flexors
and notes the location of the
heel where significant
resistance is appreciated
30.
31. Physical Criteria
– Skin Texture (-1 to 5)
• Before the development of epidermis with
its stratum corneum, the skin is
transparent and adheres somewhat to the
examiner’s finger.
• Later it smoothens, thickens and produces
a lubricant, the vernix, that dissipates
toward the end of gestation
• At term and post-term, the fetus expel
meconium into the amniotic fluid. This
may add an accelerating effect to the
drying process, causing peeling, cracking,
dehydration and imparting a parchment,
then leathery, apperance to the skin
32. Physical Criteria
– Lanugo Hair (-1 to 4)
• Fine downy hair covering fetus
from 20-28 weeks
• Disappears around face and
anterior trunk by around 28
weeks
• Term infants may have
a few patches over
shoulders
• Examine on the upper
and lower areas of the
infant’s back
33. Physical Criteria
– Plantar Creases (-1 to 4)
• The first appearance of a crease appears
on the anterior sole at the ball of the foot.
This may be related to foot flexion in
utero, but is contributed to by
dehydration of the skin
• Appears by 28-30 weeks and cover the
anterior portion of the plantar surface of
the foot
• Extend toward the heel as gestational age
increases
• After 12 hours sole creases are not valid
indicator of gestational age due to drying
of the skin
34. Physical Criteria
– Breast Bud (-1 to 4)
• Breast bud consists of breast tissue
that is stimulated to grow by
maternal estrogens and fatty
tissue, which is dependent upon
fetal nutritional status
• Note the size of the areola and the
presence or absence of stippling.
Next, palpate the breast tissue
beneath the skin by holding it
between thumb and forefinger,
estimate its diameter in
millimeters
35. Physical Criteria
–Ear Cartilage and Eyelids (-1 to 4)
• The pinna of the fetal ear changes its
configuration and increases in
cartilage content as maturation
progresses.
• Assessment includes:
1. palpation for cartilage thickness and
2. folding the pinna forward towards
the face and releasing it
• In very premature infants, the
pinnae may remain folded when
released. In such infants, the
examiner notes the state of eyelid
development as an additional
indicator of fetal maturation
36. Physical Criteria
– Male Genitals (-1 to 4)
• Testicles found inside the rugated
zone are considered descended
• In extreme prematurity, the scrotum
is flat and smooth
• At term to post-term, the scrotum
may become pendulous and may
actually touch the mattress when the
infant lies supine
• In true crptorchidism, the scrotum on
the affected side appears
uninhabited, hypoplastic and with
underdeveloped rugae. In such cases,
the normal side should be scored, or if
bilateral, a score similar to that
obtained for the other maturational
criteria should be assigned
37. Physical Criteria
– Female Genitals (-1 to 4)
• To examine the infant
female, the hips should be
only partially abducted (45°
from the horizontal with
infant lying supine)
• Exaggerated adbuction may
cause the clitoris and labia
minora to appear more
prominent, whereas
adduction may cause the
labia majora to cover over
them