Fenton Preterm Growth Chart for Boys

Length
Head Circumference

Weight

Gestational age (weeks)

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Name Date of Birth Record #

Date Size for Gestational Age
Age in Weeks SGA
Length
AGA
Head Circumference
Weight LGA
MATURATIONAL ASSESSMENT OF GESTATIONAL AGE (New Ballard Score)

NAME_________________________________ SEX ____________________________________

HOSPITAL NO. _________________________ BIRTH WEIGHT__________________________
RACE _________________________________ LENGTH________________________________
DATE/TIME OF BIRTH___________________ HEAD CIRC. ____________________________
DATE/TIME OF EXAM __________________ EXAMINER _____________________________
AGE WHEN EXAMINED _________________
APGAR SCORE: 1 MINUTE ____________ 5 MINUTES ____________ 10 MINUTES _____________

NEUROMUSCULAR MATURITY
SCORE
SCORE RECORD
NEUROMUSCULAR Neuromuscular _______
MATURITY SIGN
SCORE
-1 0 1 2 3 4 5 HERE Physical _____________
Total ________________

POSTURE
MATURITY RATING

SQUARE WINDOW SCORE WEEKS

(Wrist)
>90 90 60 45 30 0 -10 20

ARM RECOIL -5 22
180 140 180 110 140 90 110 <90
0 24

POPLITEAL ANGLE 5 26
180 160 140 120 100 90 <90
10 28
SCARF SIGN 15 30

20 32
HEEL TO EAR
25 34

30 36
TOTAL NEUROMUSCULAR
MATURITY SCORE 35 38
PHYSICAL MATURITY 40 40
SCORE RECORD
PHYSICAL 45 42
MATURITY SIGN
SCORE
-1 0 1 2 3 4 5 HERE
50 44
sticky gelatinous superficial cracking parchment leathery
smooth pink
SKIN friable red peeling & / or pale areas deep cracking cracked
visible veins
transparent translucent rash, few veins rare veins no vessels wrinkled
GESTATIONAL AGE
(weeks)
LANUGO none sparse abundant thinning bald areas mostly bald By dates _____________
By ultrasound ________
heel-toe anterior By exam _____________
>50 mm faint creases creases over
PLANTAR 4050 mm: -1 transverse
no crease red marks ant. 2/3 entire sole
SURFACE < 40 mm: -2 crease only

barely flat areola stippled areola raised areola full areola

BREAST imperceptible
perceptible no bud 12 mm bud 34 mm bud 510 mm bud

lids fused lids open sl. curved well-curved

formed & firm thick cartilage
EYE / EAR loosely: -1 pinna flat pinna; soft; pinna; soft but
instant recoil ear stiff
tightly: -2 stays folded slow recoil ready recoil

testes in testes testes

GENITALS scrotum flat, scrotum empty upper canal testes down
(Male)
descending pendulous
smooth faint rugae good rugae
rare rugae few rugae deep rugae
clitoris prominent prominent majora & majora
GENITALS clitoris & majora large
(Female)
prominent clitoris & small minora equally cover clitoris
enlarging minora small
& labia flat labia minora minora prominent & minora

Reference TOTAL PHYSICAL

Ballard JL, Khoury JC, Wedig K, et al: New Ballard Score, expanded to include extremely premature infants.
J Pediatr 1991; 119:417423. Reprinted by permission of Dr Ballard and MosbyYear Book, Inc. MATURITY SCORE

Provided as a public service from Abbott Nutrition.

91898/SEPTEMBER 2014 LITHO IN USA