Dubowitz Score

Neurologic sign Posture

0 Wrists arms hips and legs straight 90o 90o 180o 180o 180o Leg straight toes reach ear Elbow to opposite axillary line Head lags without forward movement at 90o to body axis Head droops down and back greatly arched arms & legs straight

1 Wrist bent and legs slightly bent 60o 75o 90-180o 90-180o 160o Leg straight toes reach chin Elbow to opposite midclavicular line Head slightly forward but does not reach body axis Heads slightly raised and back less curved

2 Elbows hips and legs bent but do not reach 90o 45o 45o <90o <90o 130o Knee slightly bent, heel reaches 140o from prone Elbow to midline Head in line with body axis

3 Elbow hips and legs bent to 90o 30o 20o NA NA 110o Knees bent heel reaches 120o from prone Elbow to axillary line Head bent forward beyond body axis Head in line with body axis back straight

4 Elbows & legs drawn close to body 0o 0o NA NA 90o Knee bent to 90o heel reaches 30o from prone NA

5 NA

Square window (wrist) Ankle dorsoflexion Arm recoil Leg recoil Popliteal angle Heel to ear

NA NA NA NA <90o NA

Scarf sign

NA

Head lag

NA

NA

Ventral suspension

Head raised but not to body axis back slightly curved

Head raised above body axis back straight

NA

External sign

Edema

Skin texture

Obvious edema of hands and feet pitting over tibia Very thin gelatinous

No obvious edema of hands & feet pitting over tibia Thin and smooth

No edema

NA

NA

Smooth medium thickness; rash or superficial peeling Pale pink; variable over body A few large vessels seen over the abdomen Hair thinning especially over lower back Definite red marks over > anterior 1/3; indentations over < anterior 1/3 Areola stippled edge not raised diameter <0,75 cm Breast tissue on both sides 1 or both 0,51,0 cm Partial incurving whole of upper pinna Cartilage to edge of pinna but soft in places ready recoil Labia majora completely cover labia minora At least one testis right down

Skin color

Dar red

Uniformly pink Veins & tributaries seen Abundant; long & thick over whole back Faint red marks over anterior half of sole Nipple welldefined areola smooth & flat diameter <0,75 cm Breast tissue on one or both sides < 0,5 cm diameter Incurving of part of edge of pinna Pinna soft easily folded slow recoil Labia majora almost cover labia minora At least one testis high in scrotum

Skin opacity

Lanugo

Numerous veins & venules seen especially over abdomen None

Slight thickening superficial cracking & peeling especially of hands & feet Pale; only pink over ears lips palms and soles A few large vessels seen indistinctly over the abdomen Small amount of lanugo & bald areas Indentations over more than anterior 1/3 Areola stippled edge raised Diameter >0,75 cm Breast tissue both sides one or both > 1,0 cm Well-defined incurving whole of upper pinna Pinna from cartilage to edge instant recoil NA

Thick & parchmentlike superficial or deep cracking NA

No blood vessels seen

Plantar creases

No skin creases

At least half of back devoid of lanugo Definite deep indentations more than anterior 1/3 NA

Nipple formation

Nipple barely visible no areola No breast tissue palpable Pinna flat and shapeless little or no incurving of edge Pinna soft easily folded no recoil Labia majora widely separated Labia minora protruding Neither testis in scrotum

Breast size

NA

Ear form

NA

Ear firmness

NA

Genitals female

NA

Genitals male

NA

NA