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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 0 1 2 3 4 5 posture wrists, arms, hips and legs straight wrists bent and legs slightly bent elbows, hips and legs bent but do not reach 90° elbows, hips and legs bent to 90° elbows & legs drawn close to body NA square window (wrist) 90° 60° 45° 30° 0° NA ankle dorsiflexion 90° 75° 45° 20° 0° NA arm recoil 180° 90-180° < 90° NA NA NA leg recoil 180° 90-180° < 90° NA NA NA popliteal angle 180° 160° 130° 110° 90° < 90° heel to ear leg straight, toes reach ear leg straight, toes reach chin knee slightly bent, heel reaches 140° from prone knee bent, heel reaches 120° from prone knee bent to 90°, heel reaches 90° from prone NA scarf sign elbow to opposite axillary line elbow to opposite midclavicular line elbow to midline elbow to axillary line NA NA head lag head lags without for-ward move-ment, at 90° to body axis head slightly forward but does not reach body axis head in line with body axis head bent forward beyond body axis NA NA ventral suspension heads droops down and back greatly arched, arms & legs straight heads slightly raised and back less curved head raised but not to body axis, back slightly curved head in line with body axis, back straight head raised above body axis, back straight NA   External Signs 0 1 2 3 4 edema obvious edema of hands and feet, pitting over tibia no obvious edema of hands & feet, pitting over tibia no edema NA NA skin texture very thin, gelatinous thin and smooth smooth, medium thick-ness; rash or superficial peeling slight thick-ening, super-ficial crack-ing & peeling, especially of hands & feet thick & parchment-like, superficial or deep cracking skin color dark red uniformly pink pale pink; variable over body pale; only pink over ears, lips, palms or soles NA skin opacity numerous veins & venules seen, especially over abdomen veins & tributaries seen a few large vessels seen over the abdomen a few large vessels seen indistinctly over the abdomen no blood vessels seen lanugo none abundant; long & thick over whole back hair thinning, especially over lower back small amount of lanugo & bald areas at least half of back devoid of lanugo plantar creases no skin creases faint red marks over anterior half of sole definite red marks over > anterior 1/3; indentations over < anterior 1/3 indentations over more than anterior 1/3 definite deep indentations over more than anterior 1/3 nipple formation nipple barely visible, no areola nipple well-defined, are-ola smooth & flat, diameter < 0.75 cm areola stippled, edge not raised, diameter < 0.75 cm areola stippled, edge raised, diameter > 0.75 cm NA breast size no breast tissue palpable breast tissue on one or both sides, < 0.5 cm diameter breast tissue on both sides, 1 or both 0.5 – 1.0 cm breast tissue both sides, one or both > 1.0 cm NA ear form pinna flat and shapeless, little or no incurving of edge incurving of part of edge of pinna partial incurving whole of upper pinna well-defined incurving, whole of upper pinna 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 pinna firm, cartilage to edge, instant recoil NA genitals, female labia majora widely separated, labia minora protruding labia majora almost cover labia minora labia majora completely cover labia minora NA NA genitals, male neither testis in scrotum at least one testis high in scrotum at least one testis right down 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. <>

 

 

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