Determining gestational age of the newborn
1. PostureAs the fetus approaches term, the posture becomes more flexed. By placing the newborn on its back in a relaxed posture, the flexion of the hips should result in a frog-like posture, where the knees will naturally draw up. The more term the baby, the more flexed the hips will be.
2. Square windowTo test the square window, the healthcare professional performing the assessment straightens the baby’s fingers and applies gentle pressure to the back of the hand (close to the fingers). Preterm babies will have greater angles of flexion at the wrist. The younger the gestational age, the less flexibility at the wrist.
3. Arm recoilThis test assesses the passive flexor tone of the newborn’s biceps muscle, by measuring the angle of recoil following a brief extension of the upper arm. To test arm recoil:
- next, take the baby’s hand and briefly set the elbow in flexion, before momentarily extending the arm before releasing the hand.
4. Popliteal angleGently press the baby’s thigh against their abdomen and measure the popliteal angle by moving the foot gently towards the head, until the first sign of resistance. If you haven’t come across the word before, popliteal refers to the area behind the knee. You will find that babies born at term are less flexible, with about a 90° popliteal angle. With very preterm neonates, the leg straightens to a 180° angle.
5. Scarf signThe scarf sign can be assessed by grasping the baby’s hand and attempting to cross their arm over the body towards their neck. The arms of term babies will meet resistance before crossing the mid-line, while preterm babies cross the elbow past the mid-line with no resistance.
Your taskAccess the online version of The New Ballard Score or download and print a PDF copy for your reference. Take a few minutes to review the scoring criteria and then move to the quiz in the next step to put theory into practice.
ReferencesArshpreet, D. (2017). Validity of Modified Ballard Score after 7 Days of Life. International Journal of Medical Research and Health Sciences, 6(7), 79-83.
Assessment of the Newborn
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