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 Signs posture 0 1 2 3 4 elbows & legs drawn close to body 0 5 NA

wrists arms wrists bent elbows hips elbows hips hips and and legs and legs and legs legs straight slightly bent bent but do bent to 90 not reach 90 90 60 45 30

square window (wrist) ankle dorsiflexion arm recoil leg recoil popliteal angle heel to ear

NA

90 180 180 180 leg straight toes reach ear

75 90-180 90-180 160 leg straight toes reach chin

45 < 90 < 90 130 knee slightly bent heel reaches 140 from prone elbow to midline

20 NA NA 110 knee bent heel reaches 120 from prone elbow to axillary line

0 NA NA 90 knee bent to 90 heel reaches 90 from prone NA

NA NA NA < 90 NA

scarf sign

elbow to elbow to opposite opposite axillary line midclavicular line

NA

head lag

head lags head slightly head in line without for- forward but with body ward movedoes not axis ment at 90 reach body to body axis axis heads droops down and back greatly arched arms & legs straight heads slightly raised and back less curved

head bent forward beyond body axis

NA

NA

ventral suspension

head raised head in line head raised but not to with body above body body axis axis back axis back back slightly straight straight curved

NA

External Signs edema

0 obvious edema of hands and feet pitting over tibia very thin gelatinous

1 no obvious edema of hands & feet pitting over tibia thin and smooth

2 no edema

3 NA

4 NA

skin texture

smooth medium thickness; rash or superficial peeling

slight thickthick & ening superparchmentficial crack-ing like & peeling superficial or especially of deep hands & feet cracking pale; only pink over ears lips palms or soles NA

skin color

dark red

uniformly pink

pale pink; variable over body

skin opacity

numerous veins & veins & tibutaries seen venules seen especially over abdomen none

a few large vessels seen over the abdomen

a few large vessels seen indistinctly over the abdomen small amount of lanugo & bald areas

no blood vessels seen

lanugo

abundant; long hair thinning & thick over especially over whole back lower back faint red marks over anterior half of sole

at least half of back devoid of lanugo

plantar creases

no skin creases

definite red indentations definite deep marks over > over more than indentations anterior 1/3; anterior 1/3 over more indentations than anterior over < anterior 1/3 1/3 NA

nipple formation

nipple barely visible no areola

nipple wellareola stippled areola stippled defined are-ola edge not edge raised 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 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 pinna flat and incurving of partial well-defined shapeless little part of edge of incurving incurving or no incurving pinna whole of upper whole of upper of edge pinna pinna

NA

ear form

NA

ear firmness

pinna soft easily folded no recoil

pinna soft easily folded slow recoil

cartilage to edge of pinna but soft in places ready recoil labia majora completely cover labia minora at least one testis right down

pinna firm cartilage to edge instant recoil NA

NA

genitals female

labia majora widely separated labia minora protruding neither testis in scrotum

labia majora almost cover labia minora

NA

genitals male

at least one testis high in scrotum

NA

NA

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