Таблица.  Физикальная оценка новорожденного. Перевести на русский язык = Translate into Russian с. 601-603. Модификация: Riordan J. Breastfeeding and Human Lactation, 3rd ed., Dorling Kindersley, 2004, 846 p., см.: Физиология человека: Литература. Иллюстрации., см.: Система репродукции. Литература.
№	Нормальные значения	Варианты нормы	Отклонения от нормальных значений
1.  Vital Signs
1.1	•  Temperature Axillary	•  36,5 - 37,4 °С •  97,9 - 98,0 °F	•  < 36,5 •  > 37,4 °С
1.2	•  Pulse 120.140 beats/minute	•  120 - 140  beats / minute •  Increased with crying •  Decreased when sleeping	•  Tachycardia •  Bradycardia < 80 to 100 •  Associated with color changes
1.3	•  Respirations 30.60/minute	•  Increased during first period of reactivity and with crying •  Decreased when sleeping	—
2.  Measurement
2.1	•  Head circumference 33,35 cm (13,14 in.)	•  Molding may decrease head circumference	•  Head < 10th or > 90th percentile
2.2	•  Chest circumference 30,5 - 33,0 cm (12.13 in.)	—	—
2.3	•  Head to heel length 48–53 cm (19–21 in.)	—	—
2.4	•  Birth weight 2700–4000 gm (6–9 lb)	—	•  Weight < 10th or > 90th percentile
3.  Skin
3.1	•  Bright red, smooth at birth	•  Acrocyanosis	•  Jaundice in the first 24 hours
3.2	•  Vernix caseosa, lanugo	•  Cutis marmorata––mottling when exposed to low temperature, stress, or overstimulation •  Milia •  Erythema toxicum •  Mongolian spots •  Telangiectatic nevi •  Harlequin color changes •  Jaundice after first 24 hours	•  Central or generalized cyanosis •  Pallor •  Mottling •  Plethora •  Persistent petechiae or hemorrhage or ecchymosis •  Cafe au lait spots •  Nevus flammeus
4.  Head
4.1	•  Anterior fontanelle 2.5.4.0 cm (1.1.75 in.), diamondshaped	•  Molding after vaginal birth •  Fontanelle bulging when crying	•  Fused sutures •  Depressed or bulging fontanelles when quiet
4.2	•  Posterior fontanelle 0.5.1 cm (0.2.0.4 in.), triangularshaped	•  Caput succedaneum •  Cephalhematoma	—
4.3	•  Soft, flat fontanelles	—	—
5.  Eyes
5.1	•  Edematous lids •  Absence of tears •  Slate gray, dark blue, or brown •  Positive red, corneal, pupillary, and blink reflex •  Fixes on objects, follows to midline	•  Subconjunctival hemorrhages •  Epicanthal folds in Asian newborns	•  Purulent discharge •  Upward slant of eyes •  Iris pink color •  Constricted or dilated pupil •  Absence of red, corneal, papillary reflex •  Inability to follow objects to the midline •  Sclera yellow
6.  Ears
6.1	•  Pinna flexible, well formed, level with outer canthus of the eye	•  Pinna flat against the head	•  Low placement of ears
7.  Nose
7.1	•  Patent •  Thin, white nasal discharge	•  Flattened, bruised, or slightly deviated	•  Nonpatent •  Thick, bloody discharge •  Nasal flaring
8.  Mouth/Throat
8.1	•  Intact, arched palate •  Midline uvula •  Tongue centered in the mouth •  Reflexes: sucking, rooting, gagging, extrusion •  Vigorous cry	•  Natal teeth •  Epstein’s pearls	•  Cleft lip •  Cleft palate •  Large, protruding tongue •  Drooling or copious salivation •  Candidiasis..white, adherent, thick patches on tongue, palate, buccal surfaces •  Weak, high-pitched cry
9.  Neck
9.1	•  Short, thick •  Tonic neck reflex	•  Torticollis	•  Extra skinfolds or webbing •  Resistant to flexion •  Absence of tonic neck reflex
10.  Chest
10.1	•  Equal anteroposterior and lateral diameter •  Smooth clavicles •  Breast enlargement level with outer canthus of the eye	•  Supernumerary nipples •  Thin breast secretions	•  Crepitus or asymmetry over clavicle •  Depressed sternum •  Marked retractions •  Asymmetrical expansion •  Wide-spaced nipples
11.  Lungs
11.1	•  Bilateral bronchial breath sounds •  Periodic breathing	•  Crackles immediately after birth	•  Inspiratory stridor •  Expiratory grunting •  Retractions •  Unequal breath sounds •  Apnea •  Persistent fine crackles or wheezing •  Peristaltic sounds
12.  Abdomen
12.1	•  Cylindrical shape •  Soft to palpation •  Umbilical cord bluish white at birth, with 2 arteries and 1 vein •  Bowel sounds present •  Femoral pulses equal bilaterally	•  Firm to palpation when crying •  Umbilical hernia •  Diastasis recti	•  Abdominal distention •  Localized bulging •  Absent bowel sounds •  Drainage or blood at umbilical cord •  Absent or unequal femoral pulses •  Visible peristaltic waves
13.  Genitalia
13.1	Female •  Labia majora and clitoris edematous •  Urethral meatus behind clitoris •  Vernix caseosa between labia •  Urination within first 24 hours	•  Blood-tinged, mucous discharge •  Hymenal tag	•  Fused labia •  Absence of vaginal opening •  Masses in labia •  Enlarged clitoris with urethral meatus at tip •  Ambiguous genitalia •  No urination within first 24 hours
13.2	Male •  Urethral opening at tip of penis •  Palpable testes •  Scrotum: rugae, edematous, pendulous, deeply pigmented in dark-skinned newborns •  Smegma •  Urination within first 24 hours	•  Nonretractable foreskin •  Urethral opening covered by prepuce •  Testes palpable in inguinal canal •  Small scrotum	•  Hypospadius •  Epispadius •  Chordee •  Testes nonpalpable in scrotum or inguinal canal •  Hypoplastic scrotum •  Hydrocele •  Masses in scrotum •  Discoloration of testes •  Ambiguous genitalia •  No urination within first 24 hours
14.  Back/Rectumt
14.1	•  Spine intact, no deviations, openings, or masses •  Trunk incurvation reflex •  Patent anal opening •  Anal reflex •  Meconium passed within first 24 hours	—	•  Anal fissures or fistulas •  Imperforate anus •  Absent anal reflex •  No meconium within 36 - 48 hours •  Pilonidal cyst or sinus •  Tuft of hair •  Spina bifida
15.  Extremities
15.1	•  Ten fingers and toes •  Full range of motion •  Pink nail beds •  Creases on anterior two thirds of sole •  Symmetrical extremeties •  Equal muscle tone bilaterally •  Equal bilateral brachial pulses •  Equal leg and gluteal folds	•  Partial syndactyly between second and third toes •  Second toe overlapping third toe •  Wide gap between hallux and second toes •  Asymmetric length of toes •  Dorsiflexion and shortness of hallux	•  Polydactyly •  Syndactyly (webbing) •  Persistent nail bed cyanosis •  Nail beds yellowed •  Transverse palmar crease •  Fractures •  Decreased or absent range of motion •  Unequal leg or gluteal folds •  Limited hip abduction •  Audible click with abduction •  Asymmetry

Таблица.  Образец бланка теста для оценки возраста недоношенного новорожденного. См. файл 15_8. Модификация: Ballard J.L., Khoury J.C., Wedig K., et al. New Ballard Score, expanded to include extremely premature infants. J. Pediatrics, 1991, 119, 417-423, см.: New Ballard Score Maturational Assessment of Gestational Age.
№
	Шкалы признаков	Градации признаков шкал							X
1	Кожа Skin	Влажная тонкая просвечивающая. Sticky friable transparent	Cтуднеобразно-красная полупрозрачная. Gelatinous red, translucent	Равномерно розовая, просвечивают многие вены. Smooth pink, visible veins	Поверхностное шелушение и/или сыпь, просвечивают немногочисленные вены. Superficial peeling and/or rash, few veins	Области лёгкого поверхностного растрескивания, просвечивают немногочисленные вены. Cracking pale areas, rare veins	Глубокое растрескивание, подобное пергамину, кровеносные сосуды не просвечивают. Parchment deep cracking, no vessels	Кожа испещрённая трещинами, морщинистая. Leathery cracked wrinkled
2	Пушковые волосы Lanugo	none	sparse	abundant	thinning	bald areas	mostly bald
3	Поверхность подошвы стопы Plantar Surface	heel–toe 40–50 mm:–1 <40 mm:–2	>50 mm no crease	faint red marks	anterior transverse crease only	creases ant. 2/3	creases over entire sole
4	Грудные железы Breast	imperceptible	barely perceptible	flat areola no bud	stippled areola 1–2 mm bud	raised areola 3–4 mm bud	full areola 5–10 mm bud
5	Глаза / Уши Eye / Ear	lids fused loosely:–1 tightly:–2	lids open pinna flat stays folded	sl. curved pinna; soft; slow recoil	well–curved pinna; soft but ready recoil	formed & firm instant recoil	thick cartilage ear stiff
6	Мужские гениталии Genitals male	scrotum flat, smooth	scrotum empty faint rugae	testes in upper canal rare rugae	testes descending few rugae	testes down good rugae	testes pendulous deep rugae
7	Женские гениталии Genitals female	clitoris prominent, labia flat	prominent clitoris small labia minora	prominent clitoris enlarging minora	majora & minora equally prominent	majora large minora small	majora cover clitoris & minora
8	Суммарное количество баллов всех шкал    Total physical maturity score
Примечание:
порядковая шкала порядковая переменная      1.  Posture Total body muscle tone is reflected in the infant's preferred posture at rest and resistance to stretch of individual muscle groups. As maturation progresses, the fetus gradually assumes increasing passive flexor tone that proceeds in a centripetal direction, with lower extremities slightly ahead of upper extremities. For example, very early in gestation only the ankles are flexed. Knees will flex as wrists just begin to flex. Hip flexion, then adduction are just ahead of elbow, then shoulder girdle flexion. The preterm infant primarily exhibits unopposed passive extensor tone, while the infant approaching term shows progressively less opposed passive flexor tone. To elicit the posture item, the infant is placed supine (if found prone) and the examiner waits until the infant settles into a relaxed or preferred posture. If the infant is found supine, gentle manipulation (flex if extended; extend if flexed) of the extremities will allow the infant to seek the baseline position of comfort. Hip flexion without adduction results in the frog-leg position as depicted in posture square #3. Hip adduction accompanying flexion is depicted by the acute angle at the hips in posture square #4. The figure that most closely depicts the infant's preferred posture is selected.      2. Податливость кисти. Податливость кисти к пассивному сгибанию зависит от эластичности мышц разгибателей кисти. Чем выше степень развития плода, тем меньше эластичность мышц разгибателей и больше податливость кисти новорожденного ребёнка. Показателем податливости кисти является угол между плоскостями ладони и предплечья новорожденного при сгибании кисти ребёнка. Величина угла может иметь значения: >90°, 90°, 60°, 45°, 30°, and 0°. Чем меньше указанный угол, тем меньше эластичность мышц разгибателей кисти, больше податливость кисти и выше степень развития новорожденного. Для оценки указанного угла обследующий выпрямляет пальцы новорожденного ребёнка и лёгким давлением сгибает кисть. Wrist flexibility and/or resistance to extensor stretching are responsible for the resulting angle of flexion at the wrist. The examiner straightens the infant's fingers and applies gentle pressure on the dorsum of the hand, close to the fingers. From extremely pre-term to post-term, the resulting angle between the palm of the infant's hand and forearm is estimated at; >90°, 90°, 60°, 45°, 30°, and 0°. The appropriate square on the score sheet is selected.      3. Ответная реакция на . Arm Recoil This maneuver focuses on passive flexor tone of the biceps muscle by measuring the angle of recoil following very brief extension of the upper extremity. With the infant lying supine, the examiner places one hand beneath the infant's elbow for support. Taking the infant's hand, the examiner briefly sets the elbow in flexion, then momentarily extends the arm before releasing the hand. The angle of recoil to which the forearm springs back into flexion is noted, and the appropriate square is selected on the score sheet. The extremely pre-term infant will not exhibit any arm recoil. Square #4 is selected only if there is contact between the infant's fist and face. This is seen in term and post term infants. Care must be taken not to hold the arm in the extended position for a prolonged period, as this causes flexor fatigue and results in a falsely low score due to poor flexor recoil.      4. Breast The breast bud consists of breast tissue that is stimulated to grow by maternal estrogens and fatty tissue which is dependent upon fetal nutritional status. the examiner notes the size of the areola and the presence or absence of stippling (created by the developing papillae of Montgomery). The examiner then palpates the breast tissue beneath the skin by holding it between thumb and forefinger, estimating its diameter in millimeters, and selects the appropriate square on the score sheet. Under- and over-nutrition of the fetus may affect breast size variation at a given gestation. Maternal estrogen effect may produce neonatal gynecomastia on the second to fourth day of extrauterine life.      5. Popliteal Angle This maneuver assesses maturation of passive flexor tone about the knee joint by testing for resistance to extension of the lower extremity. With the infant lying supine, and with diaper re-moved, the thigh is placed gently on the infant's abdomen with the knee fully flexed. After the infant has relaxed into this position, the examiner gently grasps the foot at the sides with one hand while supporting the side of the thigh with the other. Care is taken not to exert pressure on the hamstrings, as this may interfere with their function. The leg is extended until a definite resistance to extension is appreciated. In some infants, hamstring contraction may be visualized during this maneuver. At this point the angle formed at the knee by the upper and lower leg is measured. Note: a) It is important that the examiner wait until the infant stops kicking actively before extending the leg. b) The prenatal frank breech position will interfere with this maneuver for the first 24 to 48 hours of age due to prolonged intrauterine flexor fatigue. The test should be repeated once recovery has occurred; alternately, a score similar to those obtained for other items in the exam may be assigned.      6. Scarf Sign This maneuver tests the passive tone of the flexors about the shoulder girdle. With the infant lying supine, the examiner adjusts the infant's head to the midline and supports the infant's hand across the upper chest with one hand. the thumb of the examiner's other hand is placed on the infant's elbow. The examiner nudges the elbow across the chest, felling for passive flexion or resistance to extension of posterior shoulder girdle flexor muscles. The point on the chest to which the elbow moves easily prior to significant resistance is noted. Landmarks noted in order of increasing maturity are: full scarf at the level of the neck (-1); contralateral axillary line (0); contralateral nipple line (1); xyphoid process (2); ipsilateral nipple line (3); and ipsilateral axillary line (4).      7. Heel to Ear This maneuver measures passive flexor tone about the pelvic girdle by testing for passive flexion or resistance to extension of posterior hip flexor muscles. The infant is placed supine and the flexed lower extremity is brought to rest on the mattress alongside the infant's trunk. The examiner supports the infant's thigh laterally alongside the body with the palm of one hand. The other hand is used to grasp the infant's foot at the sides and to pull it toward the ipsilateral ear. The examiner fells for resistance to extension of the posterior pelvic girdle flexors and notes the location of the heel where significant resistance is appreciated. Landmarks noted in order of increasing maturity include resistance felt when the heel is at or near the: ear (-1); nose (0); chin level (1); nipple line (2); umbilical area (3); and femoral crease (4). Шкала Баллард, оценка Баллард — методика оценки гестационного возраста новорожденных. Оцениваются различные критерии, по которым затем экстраполируется гестационный возраст ребенка. Эти критерии разделены на физические и неврологические. Данная оценка позволяет определить возраст новорожденного в диапазоне от 26 до 44 недель. Шкала полагается на внутриутробные изменения плода, которым он подвергается в процессе созревания. Неврологические критерии зависят в основном от мышечного тонуса, а физические опираются на анатомические изменения. Новорожденные (в возрасте до 28 дней) находятся в состояние физиологической гипертонии. Этот тонус увеличивается весь период вынашивания, а это означает, что менее доношенный ребенок будет иметь меньший мышечный тонус. Разработана в 1979 году Жанной Баллард (Jeanne L. Ballard). = http://www.ballardscore.com/ Ballard JL, Khoury JC, Wedig K, et al: New Ballard Score, expanded to include extremely premature infants. J Pediatrics 1991; 119:417-423. Текст и видео http://www.ballardscore.com/Pages/videos.aspx New Ballard Score Maturational Assessment of Gestational Age Chapter 1: Introduction - Methods of determine gestational age - Discussion of active and passive muscle tone Chapter 2: Introduction (Continued) - Assessing Flexor tone - Assessment for 20-44 weeks gestational age - Neuromuscular Assessment - Posture - Square Window - Arm Recoil Chapter 3: Neuromuscular Assessment (continued) - Popliteal Angle - Scarf Sign - Heel to Ear Chapter 4: Physical Assessment (continued) - Lanugo (continued) - Plantar Surface - Breast - Eye/Ear: Chapter 5: Physical Assessment (continued) Assessing the female and male physical characteristics as part of the assessment of gestational age. - Genitals-Male - Genitals-Female Summary of Gestational Assessment and the New Ballard Score References : Ballard JL, Khoury JC, Wedig K, et al: New Ballard Score, expanded to include extremely premature infants. J Pediatrics 1991; 119:417-423.

СИСТЕМА РЕПРОДУКЦИИ: ОГЛАВЛЕНИЕ
СИСТЕМА РЕПРОДУКЦИИ: ТАБЛИЦЫ
СИСТЕМА РЕПРОДУКЦИИ: ИЛЛЮСТРАЦИИ
СИСТЕМА РЕПРОДУКЦИИ: ЛИТЕРАТУРА

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