CLASSIFICATION OF NEWBORNS -

BASED ON MATURITY AND INTRAUTERINE GROWTH Side 2

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

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
CM. CM.
53 42
90%
52 41
51 75% 40 HEAD CIRCUM-
50
LENGTH______ cm 39 FERENCE______ cm
50%
49 38
48 25% 37
47 10% 36 90%
46 35 75%
45 34 50%
44 33 25%
43 32 10%
42 31
41 30
40 29
39 28
38 27
37 26
36 25
35 24
34 23
33 22
32 0
31 3.60
30 GM. 3.50
0 4000 3.40
90% INTRAUTERINE WEIGHT-LENGTH RATIO
3800 3.30
WEIGHT______ gm 100 w GRAMS/L3 CENTIMETERS
75% 3600 3.20 BOTH SEXES
3400 3.10 90%
50%
3200 3.00
25% 3000 2.90 75%
2800 2.80
10%
GM. 2600 2.70
2400 2.60 50%
2200 2.50 25%
2000 2.40
1800 2.30 10%
1600 2.20
1400 2.10
1200 2.00
1000 1.90
800 1.80
600 1.70
400 1.60
0 0
PRE-TERM TERM POST-TERM 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 hrs hrs
Signature of Examiner 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 Side 1
Symbols: X - 1st Exam O - 2nd Exam

Gestation by Dates ______________________wks

am
NEUROMUSCULAR MATURITY Birth Date ______________Hour __________ pm

-1 0 1 2 3 4 5 APGAR ________________1 min _________5 min

Posture

Square
Window MATURITY RATING
(wrist) >90° 90° 60° 45° 30° 0°
score weeks
Arm Recoil -10 20
180° 140°-180° 110°-140° 90°-110° <90° -5 22
0 24
Popliteal
Angle 5 26
180° 160° 140° 120° 100° 90° <90°
10 28
Scarf Sign
15 30
20 32
25 34
Heel to Ear 30 36
35 38
40 40
45 42
PHYSICAL MATURITY 50 44

superficial parchment;
sticky; gelatinous; smooth; peeling cracking; deep leathery;
Skin friable; red; pink; &/or rash; pale areas; cracking; cracked;
transparent translucent visible veins few veins rare veins no vessels wrinkled

bald mostly SCORING SECTION

Lanugo none sparse abundant thinning areas bald

heel-toe >50 mm; faint anterior creases 1st Exam=X 2nd Exam=O
Plantar 40-50 mm: -1 no red transverse creases over
Surface <40 mm: -2 crease marks crease only ant. 2/3 entire sole Estimating
stippled raised full areola;
Gest Age
Breast imperceptible barely flat areola; areola; areola; 5-10 mm by Maturity
perceptible no bud 1-2 mm bud 3-4 mm bud bud Rating ________Weeks _________Weeks
well-curved formed
lids fused lids open; sl. curved pinna; & firm; thick
Eye/Ear loosely: -1 pinna flat; pinna; soft; soft but instant cartilage; Time of Date __________ Date __________
tightly: -2 stays folded slow recoil ready recoil recoil ear stiff Exam am am
scrotum scrotum testes in testes testes testes
Hour _______pm Hour________pm
Genitals flat; empty; upper canal; descending; down; pendulous;
male smooth faint rugae rare rugae few rugae good rugae deep rugae
Age at
prominent prominent majora majora majora
Genitals clitoris clitoris; clitoris; & minora large; cover Exam _________Hours _________Hours
female prominent; small enlarging equally minora clitoris
labia flat labia minora minora prominent small & minora

Signature ______________ ______________

Scoring system: Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, of
Lipp R. New Ballard Score, expanded to include extremely premature infants. Examiner ______________ ______________
J Pediatr. 1991;119:417-423. M.D./R.N. M.D./R.N.

Provided Courtesy of
 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.