Gestational Age Assessment

POPLITEAL ANGLE - PRETERM TERM

Measured by flexing the thigh against the abdomen and extending the lower leg to the point of resistance Preterm Lower leg can be fully extended Term If popliteal angle is <90 degrees Note: may extend with little resistance in infants in breech position at birth.

Infants whose size is not appropriate for their age are at greater risk of ... EX (LGA or SGA)

complications

SQUARE WINDOW preterm: term:

Elicited by bending the hand at the wrist until the palm is flat against the forearm as possible with gentle pressure Preterm -If palm bends only 90 degrees, probably <32 weeks Term -The more mature the infant, the smaller the angle until the palm folds flat against the forearm at term.

What is a Gestational Age Assessment? -AN EXAMINATION.. -PRESENCE OR ABSCENCE..

-An examination of the newborn's physical and neurologic characteristics to determine the number of weeks gestation -Presence or absence of developmental characteristics can help estimate gestational age

SCARF SIGN - PRETERM TERM

-Determine how far the arm will move across the chest and observe the position of the elbow when resistance is felt Preterm -Arm wraps across the body like a scarf with the elbow beyond the edge of the body Term -Elbow fails to reach the midline

ARM RECOIL - - PRETERM TERM

-Full term infants resist extension of the arms -Nurse holds arms fully flexed at elbows for 5 seconds, then extends the arms by pulling them straight down and the degree of flexion is measured Preterm -May not move arms at all Term Arms move briskly to an angle of 90 degrees or less

FEATURE: HAIR -LESS THAN 37 WEEKS= -37-38 WEEKS= -39 PLUS= -41 PLUS=

-LESS THAN 37 WEEKS= FINE AND MATTED -37-38 WEEKS= SILKY AND LIES FLAT -39 PLUS= SILKY AND LIES FLAT -41 PLUS= RECEDING HAIRLINE

FEATURE:TESTES/ SCROTUM -LESS THAN 37 WEEKS= -37-38 WEEKS= -39 PLUS= -41 PLUS=

-LESS THAN 37 WEEKS= IN CANAL -FEW ROUGAE -37-38 WEEKS= IN SCROTUM -LOTS ROUGAE -39 PLUS= PENDULOUS"HANGING DOWN" -41 PLUS= SAME

FEATURE: NAILS -LESS THAN 37 WEEKS= -37-38 WEEKS= -39 PLUS= -41 PLUS=

-LESS THAN 37 WEEKS= NONE -37-38 WEEKS= NONE -39 PLUS= EXTENDED BEYOND NAIL BED -41 PLUS= LONG NAILS

FEATURE: LANUGO HAIR -LESS THAN 37 WEEKS= -37-38 WEEKS= -39 PLUS= -41 PLUS=

-LESS THAN 37 WEEKS= PRESENT -37-38 WEEKS= SMALL AMOUNT ON BACK -39 PLUS= NONE -41 PLUS= NONE

FEATURE:LABIA MINORA -LESS THAN 37 WEEKS= -37-38 WEEKS= -39 PLUS= -41 PLUS=

-LESS THAN 37 WEEKS= PROTRUDING -37-38 WEEKS= ALMOST COVERED/ COVERED -39 PLUS=COVERED -41 PLUS= COVERED

FEATURE: EAR CARTILAGE -LESS THAN 37 WEEKS= -37-38 WEEKS= -39 PLUS= -41 PLUS=

-LESS THAN 37 WEEKS=NONE -37-38 WEEKS=SOME TO STIFF -39 PLUS=STIFF -41 PLUS=STIFF

POSTURE: - preterm: term:

-Posture and degree of flexion assessed -Completed before the quiet infant is disturbed for rest of the exam PRE-TERM: Extended & limp Arms and legs offer little resistance to movement by the examiner TERM: The more mature the infant is, the smaller the angle until the palm folds against the forearm at term

WHAT IS THE PURPOSE OF GESTATIONAL AGE ASSESSMENT? 1. 2.

1) Helps to estimate if newborn is premature, term, or post mature 2) Can then be compared with weight, length, and head circumference to see if infant is large, appropriate, or small for gestational age.

Neuro-muscular CharacterisTICS

1. POSTURE 2. SQUARE WINDOW 3. ARM RECOIL 4. POPLITEAL ANGLE 5. SCARF SIGN 6. HEEL TO EAR

FEATUREL: SOLE CREASES -LESS THAN 37 WEEKS= -37-38 WEEKS= -39 PLUS= -41 PLUS=

<37= SIGNLE ANTERIOR CREASE 37-38= ANTERIOR 1/3 TO FEW POSTERIOR 39= FULL SOLE 41= FULL SOLE

feature: BREAST TISSUE -LESS THAN 37 WEEKS= -37-38 WEEKS= -39 PLUS= -41 PLUS=

<37=NO BREAST TISSUE 37-38= 2-4MM 39 PLUS= 7MM 41 PLUS=7MM

After doing the physical and neurological assessments, need to examine THE _______________ TO DETERMINE if newborn is _________ 1. 2. 3. using ______

Anthropometric measures to determine if newborn is 1. large for gestational age (LGA), 2. appropriate for gestational age (AGA), or 3.small for gestational age (SGA) using growth charts SGA weight falls below 10th percentile LGA weight is above the 90th percentile

HEEL TO EAR

Grasp the foot and bring up toward the ear, keeping the hips flat Preterm Less resistance and flexion Term More resistance and flexion Note: inaccurate in infants in breech position at birth

feature: THE SKIN -LESS THAN 37 WEEKS -37-38 WEEKS -39 PLUS -41 PLUS

LESS 37= VISBLE VEINS, SMOOTH 37-38= FEWER VEINS 39 PLUS= NO VEINS, CRACKED SKIN 41 PLUS- CRACKED, WRINKLED, LEATHERY