New Ballard Scale

Assessment tool

As soon after birth as possible

When is the New Ballard Scale (gestational age assessment) preformed on the newborn?

Number of weeks from conception to birth

What is the MOST reliable estimation of gestational age?

1. Physical

2. Neuromuscular maturity

What two components help the practitioner determine the gestational age of the newborn?

• New Ballard scale

• Fetal growth chart

What is the name of the tool used to record gestational age assessment?

2 HOURS after birth or ASAP

When are the physical maturity tests preformed?

Within 24 HOURS of birth

When are the neuromuscular maturity tests preformed?

GLOVES until the infant has been bathed and all traces of blood, amniotic fluid, or body secretions have been removed

What personal protective equipment (PPE) does the nurse wear when performing an assessment on a newborn? Why?

• PALE, PINK, MOTTLED, CYANOTIC in EXTREMITIES

• OPAQUE skin because fat gained during last few weeks of pregnancy

• Some VESSELS on ABDOMEN

• Skin may be DRY, with superficial PEELING around the feet, ankles, and hands

• Note amount and location of VERNIX CASEOSA

• LANUGO

Describe what the nurse observes when assessing the SKIN of a TERM infant?

• THIN and TRANSPARENT skin

• Numerous VESSELS may be visible

• LANUGO ABUNDANT

Describe what the nurse observes when assessing the SKIN of a PRETERM infant?

• PEELING of skin common

• DRY and LEATHERY with DEEP CRACKS due to decrase in VERNIX (also because skin loses moisuture hours after birth)

• Superficial VESSELS NOT VISIBLE

• NAILS LONG and extend past finger

• GREEN MECONIUM staining skin and nails (passed stool in amniotic fluid for a while before delivery)

• LANUGO ABSENT

Describe what the nurse observes when assessing the SKIN of a POSTTERM infant?

White cheese like substance that covers and lubricates the skin of fetus in utero

• Gradually disappears as pregnancy progresses

• Prevalent in PRETERM and TERM

What is vernix? When is vernix more prevalent on a newborn?

Fine hair that covers the fetus in utero

• Gradually thins as gestational age increases

• Not always reliable for gestational age

What is Lanugo? When does lanugo disappear?

• PLANTAR CREASES develops and spreads downward toward the heel

• The ENTIRE surface of the foot is covered by DEEP CREASES

• Range from absent to covering the entire foot depending on MATURITY (greater number crease = greater maturity)

• Invalid measure beyond 12 HOURS after birth as foot begins to dry

Describe the soles of the feet of a term infant?

• Term: AREOLA is RAISED and NIPPLE WELL DEFINED, BREAST BUDS

• Preterm: FLAT AND SMOOTH areola

• Postterm same as term

How does the nurse assess the breast tissue of a newborn? What two items indicate that the infant is closer to TERM rather than PRETERM when assessing the breast tissue of a newborn?

26-28 WEEKS GESTATION

The eyes of a premature newborn are fused until which week of gestation?

FIRM and STANDS AWAY from the head, SPRINGS BACK QUICKLY when FOLDED (greater ear cartilage = greater maturity)

What will the ear pinna of a 35-week newborn do if folded forward against the head and released quickly?

• Size scrotal sack, presence of rugae, descent of testes

• PENDULUS (hanging) with DEEP RUGAE, testes in LOWER scrotum

Describe the key findings of the genitalia of a TERM MALE infant

• Labia MAJORA COVERS or almost covers labia MINORA and CLITORIS

• Affected by the amount of subcutaneous fat; poorly nourished or PRETERM infants may appear immature

Describe the key findings of the genitalia of a TERM FEMALE infant

• ILLNESS or ACIDOSIS, delay for several hours

• SEDATION

What newborn conditions will delay performing the neuromuscular portion of the gestational age exam?

SUPINE position; arms, knees, hips of healthy infant is FULLY FLEXED

When beginning the assessment of neuromuscular maturity on the newborn, what position does the nurse place the newborn in? Why?

Arms, knees, hips of healthy infant is FULLY FLEXED

Describe the muscle tone and positioning of a TERM infant

LIMP, PARTIALLY EXTENDED arms and legs that offer LITTLE resistance to movement

Describe the muscle tone and positioning of a PRETERM infant

Frog-like posture

Describe the muscle tone and positioning of a POSTTERM infant

If infant was in BREECH position (omit POPLITEAL and HEEL TO EAR extension)

List one reason the newborn neuromuscular assessment of the lower extremities will not be performed

• Square window sign

• Arm recoil

• Popliteal angle

• Scarf sign

• Heel to ear extension

What are the neuromuscular maturity tests?

How far can NB’s hands be flexed towards wrist?

• Term: NO DIFFICULTY FLEXING

• Preterm: LESS FLEXION, JOINTS and CARTILAGE FIRM, only bends 90 DEGREES (resembles a square window)

What characteristics of the SQUARE WINDOW SIGN are common in PRETERM vs. TERM infants?

How far do the arms spring back to a flexed position?

• Term: Arm should QUICKLY return to FULL FLEXION

• Preterm: SLUGGISH RECOIL, partial flexing with released

What characteristics of the ARM RECOIL are common in PRETERM vs. TERM infants?

How far will the NB’s knees extend? (move upward)

• Term: More RESISTANCE at 90 DEGREE angle

• Preterm: Very LITTLE or NO resistance

What characteristics of the POPLITEAL ANGLE are common in PRETERM vs. TERM infants?

How far can the elbows be moved across the NB’s chest?

• Term: Elbow FAILS to reach MIDLINE because of RESISTANCE

• Preterm: Arm can be WRAPPED across body like a SCARF

What characteristics of the SCARF SIGN are common in PRETERM vs. TERM infants?

How close can the NB’s feet be moved to the ears?

• Term: RESISTANCE, MORE DISTANCE

• Preterm: Leg remains STRAIGHT, foot extends CLOSER TO EAR

What characteristics of the HEEL TO EAR are common in PRETERM vs. TERM infants?

Each response is matched with diagrams and descriptions of assessment tool. There are corresponding numbers for each assessment.

• Total scores from assessment tool

• Ex. 40 = 40 weeks gestation or 35 = 38 weeks gestation

How does the nurse take all of the assessment data and calculate a gestational age score?

1. Respiratory distress syndrome

2. Hypothermia

3. Hypoglycemia

4. Hyperbilirubinemia

List FOUR problems associated with PREmaturity

1. Hypoglycemia (nutritional deprivation)

2. Meconium aspiration (intrauterine hypoxia)

3. Polycythemia (increase in RBC in response to hypoxia)

List THREE problems associated with POST maturity

Physical measurements that are not defined by maturity but by GROWTH DEFICIENCY (ex. 40 weeks infant is term, but SMALL for gestational age)

What is AGA, SGA, and LGA?

Average gestational age; WEIGHT BETWEEN 10-90TH percentile

What does AGA mean?

Small gestational age; WEIGHT BELOW 10TH percentile

What does SGA mean?

Large gentational age; WEIGHT ABOVE the 90TH percentile

What does LGA mean?