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King Faisal University
College of Applied Medical SciencesRespiratory Care Department
MSRT411: Perinatal and Pediatric Respiratory Care
Physical Assessment of Neonates
Ghazi Alotaibi, PhD, RRT
Lec07-Oct04
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Assessment of Neonates
• Neonates pass through transitional period after birth.
• Assessment is aimed to evaluate how well the extrauterine transition is taking place.
• RT must be familiar with assessment of respiratory system, and be aware of major abnormalities of other body systems.
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Assessment of Gestational Age
• In the past, weight was the only determinant of maturity (or immaturity).
• Different Techniques are employed nowadays:– Dubowitz Gestational Age Assessment.– Ballard Gestational Age Assessment.– Physical Examination to determine GA.
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Dubowitz Gestational Age Assessment
• Assesses 11 physical signs, and 10 neurological signs.
• Physical criteria are more accurate to determine GA.• Physical + neurological : more accurate. • Points are added up, and each number corresponds
to GA.• Accuracy: ± 2 W, if done during first 5 days of life.• Disadvantage:
– Takes time to perform !
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Ballard Gestational Age Assessment
• Simpler than Dubowitz’s.• Takes less time to performs• Includes 6 physical sings, and 6 neurological sings. • Accurate if performed between 30-42 hrs after
delivery.• Disadvantage: • less signs to assess each score has more effect on
the total score.
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Ballard GA Assessment
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Physical Examination to determine GA
• Uses only physical signs to assess GA.• Quicker, and simpler.• Provides roughly estimation of GA.• Some of physical signs used to assess GA:
– Vernix– Skin Maturity– Lanugo– Ear Recoil– Sole Creases
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VERNIX• Gray-white cheese-like substance that covers
the fetus body.• Begin to disappear in W 36, disappears by W
41-42.• Presence of vernix, indicates premature baby.
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SKIN MATURITY
• Gelatinous, transparent, with visible blood vessels indicates immature baby.
• Mature baby: should have skin with wrinkles, and no visible blood vessels.
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LANUGO• Fine hair covering shoulder,
back, forehead, cheeks.• Disappears around W 40.• It’s presence indicates immature
baby.
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EAR RECOIL
• Cartilage in the external portion of the ear starts to develop by W 28.
• If ear remain folded < W28
• If recoiled instantly term baby
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SKIN CREASES:• Wrinkles on the sole of the foot
starts from toes to the heel.• W 30: anterior part (1/2 the sole)• W 34: 2/3 of the sole.• Term: entire sole of the foot.
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Classification of Neonates according to GA
• After determining GA and Weight:
• 10th – 90th percentile: AGA• < 10th percentile: SGA• > 90th percentile: LGA
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Physical Assessment of Neonates
See Study Guide
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Silverman/Anderson Score to Evaluate degree of Respiratory Distress