Clinical teaching on assessment of gestational age ASSESSMENT OF GESTATIONAL AGE Assessment of gestational age of a baby can be done using “New Ballards Scale”. The scale can be used with neonates born between 20 - 44 weeks of gestation.

1. CLINICAL TEACHING ON ASSESSMENT OF
GESTATIONAL AGE

2. ASSESSMENT OF GESTATIONAL AGE
 Assessment of gestational age of a baby can be done
using “New Ballards Scale”. The scale can be used with
neonates born between 20 - 44 weeks of gestation.

3. SCORING SYSTEM FOR ASSESSMENT OF GESTATIONAL AGE
Criteria 0 1 2 3
1.Physical
a. Skin
texture
Test by
inspection
and pinching
very thin and
gelatinous
smooth,
medium
thickness with
superficial
peeling
thick with
peeling and
cracking over
hands and
feet
b. Lanugo
Examine on
the back
nil or scanty abundant
lanugo
thinning
lanugo at
places
scanty lanugo
with areas of
baldness
c. Planter
creases
Assess after
stretching the
skin
nil faint red
marks over
anterior half
of sole
deep
indentations
over
anterior1/3rd
to ½ of sole
deep
indentation
throughout
the sole

5. d. Breast
nodules
Test by
holding the
breast
tissue
between
the thumb
and finger
nil breast
tissue less
than 5mm
on one or
both sides
breast
tissue 5 –
10mm
breast
tissue more
than 10mm
diameter
e. Ear
firmness
Assess by
palpation
pinna feels
soft and
easily folded
into bizarre
shapes. No
recoil
soft but
some recoil
is present
some
cartilage felt
along the
edge and
recoil is
instant
pinna firm
with definite
cartilage
throughout
and instant
recoil

7. f. Genitalia
Male
neither
testes in
scrotum
at least one
testes in
the inguinal
canal and
can be
pulled
down into
the scrotum
at least one
testes
present in
the scrotum
Female labia majora
widely
separated
and labia
minora
protuding
labia majora
partly cover
labia minora
labia majora
completely
cover the
labia minora

8. 2.
Neurologica
l
a. Posture
Observe
with the
infant quiet
and in
supine
position
arms and
legs
extended
beginning
of flexion of
hips and
knees.
Arms
extended
stronger
flexion of
legs and
some
flexion of
arms
legs flexed
and
abducted
while arms
completely
flexed
b. Arm recoil
In a supine
infant the
flexed
forearm is
extended by
pulling at
hands and
then
released
no recoil or
only random
movements
arms returns
to
incomplete
flexion or
sluggish
response
arm briskly
returns to full
flexion

10. c. Popliteal angle
With infant in a
supine position, the
thigh is held in the
knee chest position
by supporting the
thighs with
examiner’s left hand.
The leg is then
extended by gentle
pressure with
examiner’s right hand
index finger placed
behind the ankle and
popliteal angle is
measured.
180° 180° - 150° 150° - 120° 120° - 90°

12. d. Head lag
With infant lying
in supine
position, the
baby is grasped
at hands and
slowly pulled
towards sitting
position. During
the procedure,
the position of
the head in
relation to trunk
is observed
complete
head lag
partial head
control
able to
maintain head
in line with
the body
brings
head
anterior
to the
body

14. e. Glabellar
tap
Tap sharply
at glabella
(mid –
point
between
eyebrows)
and look
for closure
of the eyes
absent weak
response
brisk
response
Physical score = 0 – 16 Neurological score = 0 -13
Combined total score = 0 – 29

17. Skin sticky,fr
iabl,
transpa
rent
gelati
nous,
red,
transl
ucent
smooth,
pink;
visible
veins
superfici
al
peeling
and /or
rash;
few
veins
cracking
pale
areas;
rare
veins
parchme
nt deep
cracking
novessel
s
lethargy,
cracked
wrinkled
Lenu
go
none spars
e
abundant thinning bald
areas
mostly
bald
Plant
er
surfa
ce
heel-
toe 40-
50mm:
-1<40
mm:-2
>
50mm
no
creas
es
faint red
marks
anterior
transvers
e creases
only
creases
anterior
2/3
creases
over
entire
sole

18. Breast imperc
eptible
barely
percep
tible
flat
areola,
no
bud
stippe
d
areola,
1-2mm
bud
raised
areola
3-4mm
bud
full
areola,
5-
10mm
bud
Eye/ea
r
lids
fused
loosely
: - 1
tightly:
- 2
lids
open;
pinna
flat;
stays
folded
slightly
curved
pinna;
soft
slow
well
curved
pinna;
soft but
ready
recoil
formed
and
firm,
instant
recoil
thick
cartilag
e, ear
stiff

19. Genital
s
(male)
scrotu
m flat,
smooth
scrotu
m
empty,
faint
rugae
testes
in
upper
canal,
rare
rugae
testes
descen
ding
few
rugae
testes
down,
good
rugae
testes
pendul
ous,
deep
rugae
Genitals
(female)
clitoris
promine
nt, labia
flat
clitoris
promine
nt,
small
labia
minora
clitoris
promine
nt,
enlargin
g
minora
majora
and
minora
equally
promine
nt
majora
large
minor
small
majora
cover
clitoris
and
minora
Fig: New Ballard Scale for newborn maturity rating

20. 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
Maturity Rating