Int J Gynaecol Obstet 17: 179-184, 1979
Birth Weight, Gestational Age and Other Indices of Fetal Maturity Saroj Pachauri 1 and S. M. Marwah 2 1 2
India Fertility Research Programme, Hyderabad, India Department of Preventive and Social Medicine, Bañaras Hindu University, Varanasi, India
ABSTRACT Pachauri S, Marwah SM (India Fertility Research Programme, Hyderabad, India, and Dept of Preventive and Social Medicine, Bañaras Hindu University, Varanasi, India). Birth weight, gestational age and other indices of fetal maturity. Int J Gynaecol Obstet 17: 179-184, 1979
A number of indices for evaluating the maturity of the newborn were studied. Indices of anthropometric, anatomic, reflex and physiologic development were examined to evaluate their association with birth weight and gestational age; the validity of these diagnostic indices is discussed. Studies are recommended to establish a maturity score to identify highrisk infants at birth.
Table I. Scoring of anatomic and physiologic indices. Degree of Development (Scores) Indices Anatomic indices Sole creases Ear lobule Breast nodule Nail size Scrotum Testes Clitoris Physiologic indices Moro reflex Rooting reflex Sucking reflex Grasp reflex Motor activity Rate of sucking Closure of mouth when sucking Stripping of tongue Passive resistance Forearm recoil Planter grasp Pitch of cry Intensity of cry
1
0 Only on the anterior 1/3 of sole Pliable, no cartilage developed
Up to the anterior % of sole Partially pliable, some cartilage
Not developed, or up to 2 mm Do not reach tip of fingers Small, few rugae Neither testes descended into scrotum Not visible
3 - 6 mm Just felt at tip of fingers
2 On the entire sole Full development, stiffened by thick cartilage 7 + mm Extend well beyond tip of fingers
Full, extensive rugae One testes descended into scrotum Just visible
Both testes descended into scrotum Very well visible
No reaction No reaction No reaction No grip or grip present but arm body and head not lifted off surface Weak 1 - 6 s u c k s / 1 0 sees Mouth open
Mild reaction Mild reaction Mild reaction Grip present but only arm lifted off surface
Marked reaction Marked reaction Marked reaction Arm, shoulder and head lifted off surface
Medium 7 - 1 4 s u c k s / 1 0 sees Mouth closed
Strong 1 5 - 3 0 s u c k s / 1 0 sees
Weak Floppy/weak Absent/weak Absent/weak Low Low
Moderate Moderate Medium Moderate Medium Medium
Strong Strong Strong Strong High High
Int J Gynaecol Obstet 17
180
Pachauri and Marwah
INTRODUCTION Physiologic maturity of the newborn infant is an important factor underlying the apparent effects of both birth weight and period of gestation. There is an obvious need to establish measures of physiologic maturity that can be made independent of birth weight and duration of gestation, that are of proven reliability and validity and that can be conveniently quantified. Such indices would be valuable for identifying high-risk infants and, thereby, make it possible to institute appropriate control measures. This study was conducted to evaluate the association of certain anatomic and physiologic indices of fetal maturity with birth weight and gestational age.
MATERIALS A N D M E T H O D S T h e sample under study comprised 290 single births who were delivered at Doctor Kapoor's Maternity Hospital in New Delhi, India. T h e following indices of fetal development were evaluated: (a) anthropometric indices including (I)
crown-heel length, (2) crown-rump length, (3) head circumference, (4) chest circumference and (5) cephalothoracic difference; (b) indices of anatomic development including (1) sole creases, (2) ear lobule, (3) breast nodule, (4) nail size, (5) scrotum, (6) testes and (7) clitoris; and (c) indices of physiologic development including (1) Moro reflex, (2) rooting reflex, (3) sucking reflex, (4) grasp reflex, (5) pupillary reflex, (6) motor activity, (7) rate of sucking, (8) closure of mouth while sucking, (9) stripping action of tongue while sucking, (10) forearm recoil, (11) passive resistance, (12) planter grasp, (13) pitch of cry and (14) intensity of cry. Indices 6-14 of physiologic development were evaluated for 119 infants only. T h e crown-heel and crown-rump measurements were recorded using an infantometer. T h e occipitofrontal circumference (head circumference) and the chest circumference were measured with a soft measuring tape. T h e indices of anatomic and physiologic development were assessed by the techniques used by Yatco-Zalamea et al (8) and Farr (3), respec-
2950 CROWN-HEEL LENGTH BY BIRTH-WEIGHT
CROWN-RUMP LENGTH BY BIRTH-WEIGHT 3400 r
3200
SOLE CREASES
3000
2B30
2800
2750
Z600
BREAST NODULE,
3000 r
3000 r 2700 -
V)
2800
2800 2400 -
2600 X
2600
2400 ÜJ 144 9 45-49.9 5 0 . 0 * CROWN-HEEL LENGTH IN CMS
*l X I-
3600
HEAD CIRCUMFERENCE BY BIRTH-WEIGHT
129.9 30-34.9 3 3 0 * CROWN-RUMP LENGTH IN CMS.
CHEST CIRCUMFERENCE BY BIRTH-WEIGHT
I 3000 -
or œ
z
Birth Weight, Gestational Age and Other Indices of Fetal Maturity Saroj Pachauri 1 and S. M. Marwah 2 1 2
India Fertility Research Programme, Hyderabad, India Department of Preventive and Social Medicine, Bañaras Hindu University, Varanasi, India
ABSTRACT Pachauri S, Marwah SM (India Fertility Research Programme, Hyderabad, India, and Dept of Preventive and Social Medicine, Bañaras Hindu University, Varanasi, India). Birth weight, gestational age and other indices of fetal maturity. Int J Gynaecol Obstet 17: 179-184, 1979
A number of indices for evaluating the maturity of the newborn were studied. Indices of anthropometric, anatomic, reflex and physiologic development were examined to evaluate their association with birth weight and gestational age; the validity of these diagnostic indices is discussed. Studies are recommended to establish a maturity score to identify highrisk infants at birth.
Table I. Scoring of anatomic and physiologic indices. Degree of Development (Scores) Indices Anatomic indices Sole creases Ear lobule Breast nodule Nail size Scrotum Testes Clitoris Physiologic indices Moro reflex Rooting reflex Sucking reflex Grasp reflex Motor activity Rate of sucking Closure of mouth when sucking Stripping of tongue Passive resistance Forearm recoil Planter grasp Pitch of cry Intensity of cry
1
0 Only on the anterior 1/3 of sole Pliable, no cartilage developed
Up to the anterior % of sole Partially pliable, some cartilage
Not developed, or up to 2 mm Do not reach tip of fingers Small, few rugae Neither testes descended into scrotum Not visible
3 - 6 mm Just felt at tip of fingers
2 On the entire sole Full development, stiffened by thick cartilage 7 + mm Extend well beyond tip of fingers
Full, extensive rugae One testes descended into scrotum Just visible
Both testes descended into scrotum Very well visible
No reaction No reaction No reaction No grip or grip present but arm body and head not lifted off surface Weak 1 - 6 s u c k s / 1 0 sees Mouth open
Mild reaction Mild reaction Mild reaction Grip present but only arm lifted off surface
Marked reaction Marked reaction Marked reaction Arm, shoulder and head lifted off surface
Medium 7 - 1 4 s u c k s / 1 0 sees Mouth closed
Strong 1 5 - 3 0 s u c k s / 1 0 sees
Weak Floppy/weak Absent/weak Absent/weak Low Low
Moderate Moderate Medium Moderate Medium Medium
Strong Strong Strong Strong High High
Int J Gynaecol Obstet 17
180
Pachauri and Marwah
INTRODUCTION Physiologic maturity of the newborn infant is an important factor underlying the apparent effects of both birth weight and period of gestation. There is an obvious need to establish measures of physiologic maturity that can be made independent of birth weight and duration of gestation, that are of proven reliability and validity and that can be conveniently quantified. Such indices would be valuable for identifying high-risk infants and, thereby, make it possible to institute appropriate control measures. This study was conducted to evaluate the association of certain anatomic and physiologic indices of fetal maturity with birth weight and gestational age.
MATERIALS A N D M E T H O D S T h e sample under study comprised 290 single births who were delivered at Doctor Kapoor's Maternity Hospital in New Delhi, India. T h e following indices of fetal development were evaluated: (a) anthropometric indices including (I)
crown-heel length, (2) crown-rump length, (3) head circumference, (4) chest circumference and (5) cephalothoracic difference; (b) indices of anatomic development including (1) sole creases, (2) ear lobule, (3) breast nodule, (4) nail size, (5) scrotum, (6) testes and (7) clitoris; and (c) indices of physiologic development including (1) Moro reflex, (2) rooting reflex, (3) sucking reflex, (4) grasp reflex, (5) pupillary reflex, (6) motor activity, (7) rate of sucking, (8) closure of mouth while sucking, (9) stripping action of tongue while sucking, (10) forearm recoil, (11) passive resistance, (12) planter grasp, (13) pitch of cry and (14) intensity of cry. Indices 6-14 of physiologic development were evaluated for 119 infants only. T h e crown-heel and crown-rump measurements were recorded using an infantometer. T h e occipitofrontal circumference (head circumference) and the chest circumference were measured with a soft measuring tape. T h e indices of anatomic and physiologic development were assessed by the techniques used by Yatco-Zalamea et al (8) and Farr (3), respec-
2950 CROWN-HEEL LENGTH BY BIRTH-WEIGHT
CROWN-RUMP LENGTH BY BIRTH-WEIGHT 3400 r
3200
SOLE CREASES
3000
2B30
2800
2750
Z600
BREAST NODULE,
3000 r
3000 r 2700 -
V)
2800
2800 2400 -
2600 X
2600
2400 ÜJ 144 9 45-49.9 5 0 . 0 * CROWN-HEEL LENGTH IN CMS
*l X I-
3600
HEAD CIRCUMFERENCE BY BIRTH-WEIGHT
129.9 30-34.9 3 3 0 * CROWN-RUMP LENGTH IN CMS.
CHEST CIRCUMFERENCE BY BIRTH-WEIGHT
I 3000 -
or œ
z
