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Gestational Age Assessment

Neuromuscular Maturity

  1. Obtain New Ballard score (NBS) sheet to perform the neuromuscular maturity assessment tool, following the order detailed in the tool.
  2. Observe the infant's posture while lying supine and quiet. Remove positioning tools if necessary.
  3. Perform square window. Using gentle pressure, flex the infant's hand at the wrist of the arm without the ID band, attempting to place the palm of the hand flat on the forearm. Bend the hand as far down as possible and measure the angle remaining between the palm and the forearm.
  4. Test arm recoil. Hold the infant's arms fully flexed for 5 seconds, then fully extend arms by pulling the hands down to the sides, and release quickly. Score reaction of arms.
  5. Measure popliteal angle. Place infant supine with pelvis flat on the bed. With one hand, hold the infant's thigh against the abdomen without pulling the hip off the bed. Using the other hand, gently pull up on the lower part of the same leg just until resistance is felt. Measure the angle between the thigh and the underside of the calf.
  6. Perform scarf sign. With infant supine, gently take the infant's hand and pull the arm across the infant's neck as far as possible. Score according to the position of the elbow as diagrammed on the tool.
  7. Assess heel to ear. With infant supine, grasp the infant's foot and gently pull leg up toward ear on same side as closely as possible without forcing it. Assess position of leg in relation to body.

Physical Maturity
Refer to NBS sheet to perform physical maturity assessment, following the order detailed in the tool.

  1. Assess skin. Assess color, thickness, texture, and visibility of the infant's veins.
  2. Assess lanugo (body hair) on infant's back.
  3. Assess plantar surface. Evaluate soles of infant's feet for length, as well as for presence and location of creases.
  4. Measure infant's breast. Measure in millimeters. Use two fingers, but do not use thumb during measurement.
  5. Evaluate eyes and ears.
  6. For very premature infants, assess degree of eyelid fusion.
  7. For all but very premature infants, assess shape, recoil, and cartilage content of ear.
  8. Shape: Pinna (outer edge of ear) should be well curved in the term infant.
  9. Recoil: Ear should spring back readily when folded down and released.
  10. Cartilage: Entire ear should be stiff and firm in the term infant.
  11. Assess genitals (male). Examine scrotum, noting presence of rugae (wrinkles) and location of testes.
  12. Assess genitals (female). Examine labia majora (outer), labia minora (inner), and clitoris.
  13. Return infant to original bed if moved for the assessment.
  14. Remove gloves and discard in proper trash receptacle. Perform hand hygiene.


  • Add the scores from the twelve neuromuscular and physical categories and obtain EGA from the New Ballard chart.
  • Document the procedure in the patient's record.