Dubowitz Scoring System

6 months 28 weeks

62 months 30 weeks

7 months 32 weeks

7i months 34 weeks

8 months 36 weeks

82 months 38 weeks

9 months 40 weeks

1.Posture

Completely Beginning of hypotonic flexion of thigh at hip

Stronger flexion

Frog-like attitude

Flexion of the four limbs

Hypertonic

Very hypertonic

1.Hee I ftoearr manara'

cA

cA>

3.PopJftaÜ angle

4150'

4

c4,,0°

) 100°

2100°

> 80°

4.[E0rEsll^i0m angjfeoff foott

40-50°

40-50°

C^TV

Full term

S/S^raff' sign

'Scarf sign complete with no resistance

'Scarf sign more limited

Elbow slightly passes midline

Elbow almost reaches midline

6.Ffeturrntto fftwcorn off forearm

Upper limbs very hypotonic lying in extension

Flexion of forearms begins to appear, but very weak

Strong 'return to flexion.' Flexion tone inhibited if forearm maintained 30 seconds in extension

Strong 'return to flexion.' Forearm returns very promptly to flexion after being extended for 30 seconds

Passive tone. Increase of tone with maturity illustrated by means of six clinical tests. (From Amiel-Tison, C.: Arch. Dis. Child.,43:89,1968.)

Figure 6.1A & B. Many scoring systems have been devised to assess by exam the gestational age of infants at birth. The originals are shown here in figures A & B, published by Amiel-Tison. The Dubowitz examination is one of the most complete systems, combining the general physical examination performed in the first hours of life with the neurologic evaluation carried out when the infant is at least 24 hours old. The Ballard Method abbreviates the Dubowitz scoring system and uses only 12 physical and neurologic criteria. Statistically, however, the Ballard is as accurate in assessing gestation age (± 2 weeks) as more thorough examinations and is most useful in the busy clinical setting.

Amiel Tyson Neurology

Active tone. Increase of tone with maturity illustrated by means of four tests of righting reactions. (From Amiel-Tison, C.: In Gluck, L. (ed.), Modern Perinatal Medicine, Chicago, Year book Medical Publishers, 1974, p. 347.)

Figure 6.2. A prenatal ultrasound examination showing a view of a foot. Foot length on prenatal ultrasound has been shown to correlate well with gestational age.

Figure 6.2. A prenatal ultrasound examination showing a view of a foot. Foot length on prenatal ultrasound has been shown to correlate well with gestational age.

Figure 6.3. Graphic representation of the correlation between fetal foot length and gestational age. (Mercer et al. Scatter plots of ultrasonic feetus. gestational age. AM J Obstet Gynecol 1987; 156:350 Mosby Year Book, used with permission)

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