CLASSIFICATION OF NEWBORNS BASED ON MATURITY AND INTRAUTERINE GROWTH

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

CM.
53
52
51
50
49
48
47
46
45
44
43
42
41
40
39
38
37
36
35
34
33
32
31
30
0

Side 2

WEEK OF GESTATION

WEEK OF GESTATION

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

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

90%
75%

LENGTH______ cm

50%
25%
10%

90%

WEIGHT______ gm

75%
50%
25%

GM.
2400
2200
2000
1800
1600
1400
1200
1000
800
600
400
0

10%

PRE-TERM

TERM

GM.
4000
3800
3600
3400
3200
3000
2800
2600

POST-TERM

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

HEAD CIRCUMFERENCE______ cm
90%
75%
50%
25%
10%

INTRAUTERINE WEIGHT-LENGTH RATIO

100 w GRAMS/L3 CENTIMETERS
BOTH SEXES

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
1st Exam (X)

2nd Exam (O)

LARGE FOR GESTATIONAL AGE (LGA)

APPROPRIATE FOR GESTATIONAL AGE (AGA)
SMALL FOR GESTATIONAL AGE (SGA)
Age at Exam
Signature of Examiner

hrs

hrs

M.D./R.N.

M.D./R.N.

Adapted from Lubchenco LO, Hansman C, and Boyd E: Pediatr. 1966;37:403; Battaglia FC, and Lubchenco LO: J Pediatr. 1967;71:159.

LB146 REV 6/04

1988, 1992, 1997, 1999 Mead Johnson & Company, Evansville, Indiana 47721 U.S.A.

NEWBORN MATURITY RATING & CLASSIFICATION

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

Side 1

Gestation by Dates ______________________wks

am
Birth Date ______________Hour __________ pm

NEUROMUSCULAR MATURITY
-1

APGAR ________________1 min _________5 min

Posture

Square
Window
(wrist)

MATURITY RATING
>90

90

60

45

30

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

Arm Recoil
180 140-180 110-140

90-110

<90

100

90

Popliteal
Angle
180

160

140

120

<90

Scarf Sign

Heel to Ear

PHYSICAL MATURITY
Skin

sticky;
friable;
transparent

gelatinous;
red;
translucent

smooth;
pink;
visible veins

superficial
peeling
&/or rash;
few veins

cracking;
pale areas;
rare veins

parchment;
deep
cracking;
no vessels

Lanugo

none

sparse

abundant

thinning

bald
areas

mostly
bald

Plantar
Surface

heel-toe
40-50 mm: -1
<40 mm: -2

>50 mm;
no
crease

faint
red
marks

anterior
transverse
crease only

creases
ant. 2/3

creases
over
entire sole

1st Exam=X

2nd Exam=O

Estimating
Gest Age
by Maturity
Rating

formed
& firm;
instant
recoil

thick
cartilage;
ear stiff

Time of
Exam

testes
down;
good rugae

testes
pendulous;
deep rugae

Date __________ Date __________

am
am
Hour _______pm Hour________pm

majora
large;
minora
small

majora
cover
clitoris
& minora

Age at
Exam

_________Hours

_________Hours

______________

______________

______________

______________

M.D./R.N.

M.D./R.N.

Breast

imperceptible

barely
perceptible

flat areola;
no bud

Eye/Ear

lids fused
loosely: -1
tightly: -2

lids open;
pinna flat;
stays folded

sl. curved
pinna; soft;
slow recoil

well-curved
pinna;
soft but
ready recoil

Genitals
male

scrotum
flat;
smooth

scrotum
empty;
faint rugae

testes in
testes
upper canal; descending;
rare rugae
few rugae

Genitals
female

clitoris
prominent;
labia flat

prominent
clitoris;
small
labia minora

majora
& minora
equally
prominent

SCORING SECTION

full areola;
5-10 mm
bud

stippled
raised
areola;
areola;
1-2 mm bud 3-4 mm bud

prominent
clitoris;
enlarging
minora

leathery;
cracked;
wrinkled

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.

Provided Courtesy of

Signature
of
Examiner

________Weeks _________Weeks

Unified System for Gestational Age

Evaluation 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.

Provided Courtesy of

LB146 REV 11/99

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