King Faisal University

College of Applied Medical Sciences

Respiratory Care Department
MSRT411: Perinatal and Pediatric Respiratory Care

Physical Assessment
of Neonates
Ghazi Alotaibi, PhD, RRT

Lec07-Oct04
 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.
 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.
 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 !
 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.
Ballard GA Assessment
 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
 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.
 SKIN MATURITY
• Gelatinous, transparent, with visible blood
vessels indicates immature baby.
• Mature baby: should have skin with wrinkles,
and no visible blood vessels.
 LANUGO
• Fine hair covering shoulder,
back, forehead, cheeks.
• Disappears around W 40.
• It’s presence indicates immature
baby.
 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
 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.
 Classification of Neonates
according to GA

• After determining GA and

Weight:
• 10th – 90th percentile: AGA
• < 10th percentile: SGA
• > 90th percentile: LGA
Physical Assessment of Neonates

See Study Guide

Silverman/Anderson Score to Evaluate degree of Respiratory
Distress