Prematurity Clinical Presentation

Updated: Oct 13, 2017
  • Author: Susan A Furdon, RNC, NNP-BC, MS; Chief Editor: Dharmendra J Nimavat, MD, FAAP  more...
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Presentation

History

In assessing prematurity, gestational age dating by using the mother's history can be unreliable because of uncertainty of the dates. About 20% of women have an uncertain last menstrual period (LMP).

Gestational age assessment begins prenatally with obstetric ultrasonography in the first trimester. Discovery of many fetal anomalies, unsuspected multiple gestation, location of the placenta, and an accurate dating of the pregnancy are additional major benefits of early ultrasonography.

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Physical Examination

Confirmation of gestational age in the newborn is based on physical and neurologic characteristics. In 1979, the Dubowitz scoring system for determining gestational age based on neurologic and physical parameters was revised to include 12 items. [27]  The Ballard Scoring System, revised again to include extremely low birth weight (ELBW) infants, remains the main tool clinicians use after delivery to confirm gestational age by means of physical examination. [2]

The major parts of the anatomy for physical characteristic markers are ear cartilage, sole creases, breast tissue, and genitalia. See the images below.

Preterm infant at 28 weeks' gestation. Note the sm Preterm infant at 28 weeks' gestation. Note the small amount of ear cartilage and/or flattened pinna.
Preterm infant at 33 weeks' gestation. Note the in Preterm infant at 33 weeks' gestation. Note the increased cartilage, recoil, and outer ridge curving inward.
A term infant has well-developed cartilage with in A term infant has well-developed cartilage with instant recoil.
Preterm infant at 28 weeks' gestation. Note the fl Preterm infant at 28 weeks' gestation. Note the flat sole.
Preterm infant at 33 weeks' gestation. Note the pr Preterm infant at 33 weeks' gestation. Note the presence of only an anterior crease.
Term gestation. Note the multiple creases. Term gestation. Note the multiple creases.
Preterm infant at 28 weeks' gestation. No breast t Preterm infant at 28 weeks' gestation. No breast tissue is present, and the areolae are barely visible.
Preterm infant at 33 weeks' gestation. The breast Preterm infant at 33 weeks' gestation. The breast tissue is less than 1 cm, and the areolae are raised and/or pigmented.

The physical examination and evaluation should be performed immediately after stabilization and before the expected weight loss occurs on the first day.

Hittner et al reported that regression of the vascularity of the lens capsule is an excellent tool to confirm a gestational age of 28-34 weeks. [28]

Neurologic criteria include muscle tone of the trunk and extremities and joint mobility. Reassessing the neurologic criteria 18-24 hours after birth is best to allow for recovery from maternal medication (eg, magnesium sulfate, analgesics), which may decrease tone and responsiveness.

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