 An accurate assessment incorporates size

and maturity.
 Assessment methods include:
 Mother’s menstrual history
 Prenatal ultrasonography
 Evaluation of obstetric parameters
 Postnatal maturational examinations
▪ Dubowitz Assessment of Gestational Age
▪ Lubchenco Scale
▪ New Ballard Score
 Skin
 Lanugo
 Plantar surface
 Breast
 Eyes & Ears
 Genital
 Examine the texture, color and opacity
 As the infant matures:
 More subcutaneous tissue develops
 Veins become less visible and the skin
becomes more opaque
 Physical Maturity
 Skin
▪ Before 28 weeks-
gelatinous red, friable
▪ 28-37 weeks-skin over
abdomen thin,
translucent, pink with
visible veins
▪ 37-39 weeks smooth,
pink, increased
thickness, rare veins over
abdominal wall
 Physical
Maturity
 Skin
▪ 40 Weeks-
vessels have
now appeared,
skin may be
leathery with
deep cracking
• Physical Maturity
• Lanugo
• After 20 weeks-begins to
appear
• 28 weeks-abundant
• After 28 weeks-thinning,
starts to disappear from the
face first
• 38 weeks-bald areas slight
amount may be present on
shoulders
 Plantar Surface
 Before 28 weeks-no creases
 28-32 weeks-virtually no sole
creases, faint thin red lines over
anterior aspect of foot
 34-37 weeks-1-2 anterior creases
 37-39 weeks-creases now over
the anterior 2/3 of the sole
 Physical Maturity
 Breast
 Before 28 weeks-nipples imperceptible
 28-32 weeks-nipple barely visible, no areola
 32-37 weeks-well defined nipple areola
 38-40 weeks-well defined nipple raised areola
 Physical Maturity
 Eyes
 Eyes are evaluated as either fused as seen in extremely
premature infants or open
 Before 26 weeks eyes are fused
 Physical Maturity
 Ears
 Before 34 weeks-pinna
is very immature
cartilage not present,
lies flat, remains folded
 34-37 weeks-pinna
curved with soft recoil
 37-40 weeks-formed,
firm instant recoil
 After 40 weeks-thick
cartilage ear stiff
 Physical Maturity
 Genitalia-Male
 Before 28 weeks-scrotum
empty and flat
 28-30 weeks-testes
undescended into scrotal sac
 30-36 weeks testes
descending with a few rugae
over the scrotum
 36-39 weeks-testes have
descended into scrotum which
is now pendulous and
complete with rugae
 Genitalia-Female
• Before 28 weeks-clitoris
prominent labia flat
• 28-32 weeks-prominent clitoris,
enlarging labia minora
• 33-36 weeks-labia majora widely
spaced with equally prominent
labia minora
• 33-39 weeks-labia extends over
the labia minora but not over the
clitoris
• 39 weeks-labia majora completely
covers the labia minora and clitoris
 Neuromuscular Maturity
 Posture & Tone
 Square Window
 Arm Recoil
 Popliteal Angle
 Scarf Sign
 Heel to Ear
• Neuromuscular Maturity
• Posture/Tone-Total body muscle tone is reflected in the
infants preferred posture at rest and resistance to stretch
of individual muscle groups
• Make sure infant is quiet
• The more mature an infant is the greater their tone will
be
• A more flexed position indicated greater tone
• Neuromuscular Maturity
• Posture & Tone
• Before 30 weeks-hypotonic,
little or no flexion seen
• 30-38 weeks-varying degrees
of flexed extremities
• 38-42 weeks-may appear
hypertonic
 Neuromuscular Maturity
 Square Window-wrist flexibility
and/or resistance to extensor
stretching resulting in angle or
flexion at wrist
▪ Flex hand down to wrist-
measure the angle between
the forearm & palm
▪ Before 26 weeks-wrist can’t
be flexed more than 90
degrees
▪ Before 30 weeks-wrist can be
flexed no more than 90
degrees
 36-38 weeks-wrist can be
flexed no more than
 Neuromuscular Maturity
 Arm Recoil-measures the angle of recoil following a brief
extension of the upper extremity
 For 5 seconds flex the arms while infant is in the supine
position, pulling the hands fully extend the arms to the
side, then release-measure the degree of arm flexion &
strength (recoil)
 Before 28 weeks-no recoil
 28-32 weeks-slight recoil
 32-36 weeks-recoil does not pass 90 °
 36-40 weeks-recoils to 90°
 After 40 weeks-rapid full recoil
 Neuromuscular Maturity
 Popliteal Angle-assesses
maturation of passive flexor tone
about the knee joint by testing
resistance to extension of the leg
 The angle decreases with
advancing gestational age
 Before 26 weeks-angle 180
degrees
 26-28 weeks-angle 160 degrees
 28-32 weeks-angle 140 degrees
 32-36 weeks angle 120 degrees
 Neuromuscular Maturity
 Scarf Sign-tests the passive tone of the
flexors about the shoulder girdle
 Increased resistance to this maneuver
with advancing gestational age
 Before 28 weeks-elbow passes torso
 28-34 weeks-elbow passes opposite
nipple line
 34-36 weeks-elbow can be pulled past
midline, no resistance
 36-40 weeks-elbow to midline with some
resistance
 After 40 weeks-doesn’t reach midline
 Neuromuscular Maturity
 Heel to Ear-measures
passive flexor tone about
the pelvic girdle by testing
passive flexion or resistance
to extension of the
posterior hip flexor muscles
 Breech infants will score
lower than normal
 Before 34 weeks-no
resistance
 40 weeks-great resistance
may be difficult to perform
 Total jumlah nilai
 Cocokkan jumlah pada
tabel Maturity Rating