Dubowitz Score

Overview: The score proposed by Dubowitz et al assesses an infant for the apparent gestational age
by considering both neurologic and external signs of development.

Components:

• neurological signs: 10

• external signs: 12

Neurologic 0 1 2 3 4 5
Signs
posture wrists arms wrists bent elbows hips elbows hips elbows & NA
hips and and legs and legs and legs legs drawn
legs straight slightly bent bent but do bent to 90° close to
not reach body
90°
square 90° 60° 45° 30° 0° NA
window
(wrist)
ankle 90° 75° 45° 20° 0° NA
dorsiflexion
arm recoil 180° 90-180° < 90° NA NA NA

leg recoil 180° 90-180° < 90° NA NA NA

popliteal 180° 160° 130° 110° 90° < 90°

angle
heel to ear leg straight leg straight knee slightly knee bent knee bent to NA
toes reach toes reach bent heel heel 90° heel
ear chin reaches reaches reaches 90°
140° from 120° from from prone
prone prone
scarf sign elbow to elbow to elbow to elbow to NA NA
opposite opposite midline axillary line
axillary line midclavicular
line

head lag head lags head slightly head in line head bent NA NA
without for- forward but with body forward
ward move- does not axis beyond
ment at 90° reach body body axis
to body axis axis

ventral heads heads head raised head in line head raised NA

suspension droops slightly but not to with body above body
down and raised and body axis axis back axis back
back greatly back less back slightly straight straight
arched arms curved curved
& legs
straight
External Signs 0 1 2 3 4
edema obvious edema no obvious no edema NA NA
of hands and edema of
feet pitting hands & feet
over tibia pitting over
tibia

skin texture very thin thin and smooth slight thick- thick &
gelatinous smooth medium thick- ening super- parchment-
ness; rash or ficial crack-ing like
superficial & peeling superficial or
peeling especially of deep
hands & feet cracking

skin color dark red uniformly pink pale pink; pale; only pink NA
variable over over ears lips
body palms or soles

skin opacity numerous veins & a few large a few large no blood
veins & tibutaries seen vessels seen vessels seen vessels seen
venules seen over the indistinctly
especially over abdomen over the
abdomen abdomen

lanugo none abundant; long hair thinning small amount at least half
& thick over especially over of lanugo & of back
whole back lower back bald areas devoid of
lanugo

plantar no skin faint red marks definite red indentations definite deep
creases creases over anterior marks over > over more than indentations
half of sole anterior 1/3; anterior 1/3 over more
indentations than anterior
over < anterior 1/3
1/3

nipple nipple barely nipple well- areola stippled areola stippled NA

formation visible no defined are-ola edge not edge raised
areola smooth & flat raised diameter >
diameter < diameter < 0.75 cm
0.75 cm 0.75 cm

breast size no breast breast tissue breast tissue breast tissue NA

tissue palpable on one or both on both sides 1 both sides one
sides < 0.5 cm or both 0.5 - or both > 1.0
diameter 1.0 cm cm

ear form pinna flat and incurving of partial well-defined NA

shapeless little part of edge of incurving incurving
or no incurving pinna whole of upper whole of upper
of edge pinna pinna
ear firmness pinna soft pinna soft cartilage to pinna firm NA
easily folded easily folded edge of pinna cartilage to
no recoil slow recoil but soft in edge instant
places ready recoil
recoil

genitals female labia majora labia majora labia majora NA NA

widely almost cover completely
separated labia minora cover labia
labia minora minora
protruding

genitals male neither testis in at least one at least one NA NA

scrotum testis high in testis right
scrotum down

Dubowitz score = SUM (points for each parameter)

Interpretation:

• minimum score: 0

• maximum score: 72 (neurological sign 35 external sign 37)

estimated gestational age =

= (0.2642 * (total score)) + 24.595

References:

Dubowitz LMS Dubowitz V Goldberg C. Clinical assessment of gestational age in the newborn infant. J
Pediatr. 1970; 77: 1-10