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Figure 6.12. The breast analog does not respond to hormonal stimulation until near the 35th week and thus the size of the nodule can be correlated with development. Before 34 weeks the nipple and areola are identifiable, although they are immature-looking and non-pigmented. Between 34 and 36 weeks the nipple becomes erectile and a small nubbin of breast tissue can be felt under the areola. By 36 to 38 weeks, there is usually a palpable nodule and, by term, the nodule has enlarged to 5 to 10 mm in size.

Figure 6.12. The breast analog does not respond to hormonal stimulation until near the 35th week and thus the size of the nodule can be correlated with development. Before 34 weeks the nipple and areola are identifiable, although they are immature-looking and non-pigmented. Between 34 and 36 weeks the nipple becomes erectile and a small nubbin of breast tissue can be felt under the areola. By 36 to 38 weeks, there is usually a palpable nodule and, by term, the nodule has enlarged to 5 to 10 mm in size.

Figure 6.13. In the preterm male infant the testes are undescended and the scrotum empty, as pictured here. In the preterm female infant the clitoris is relatively large, and the vulva gapes due to separation of the labia majora and minora.

Figure 6.14. Looking for epiphyseal centers in long hone radiographs is useful in the assessment of gestational age. The lower extremity radiographs show the proximal tibial epiphyseal center, which generally appears by 36 weeks gestation, being followed by the distal femoral epiphyseal center at 38 weeks gestation. In this patient no epiphyseal centers are seen, consistent with the infant's gestational age of 35 weeks. Conditions that may alter the normal appearance of the centers include hypothyroidism, congenital viral infections, and congenital syphilis.

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Figure 6.15. At 30 weeks or less the soles of the baby's feet are smooth. At 34 weeks, creases have started to appear on the anterior third of the plantar surface. By term, the entire plantar area is noticeably creased. In the post-term infant shown here, the soles show excessive creasing on the plantar surface togedier with dry peeling skin.

Figure 6.15. At 30 weeks or less the soles of the baby's feet are smooth. At 34 weeks, creases have started to appear on the anterior third of the plantar surface. By term, the entire plantar area is noticeably creased. In the post-term infant shown here, the soles show excessive creasing on the plantar surface togedier with dry peeling skin.

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