An examination called the Dubowitz/Ballard Examination for Gestational Age is often used. A baby's gestational age often can be closely estimated using this examination. The Dubowitz/Ballard Examination evaluates a baby's appearance, skin texture, motor function, and reflexes. The physical maturity part of the examination is done in the first two hours of birth. The neuromuscular maturity examination is completed within 24 hours after delivery.

Points are given for each area of assessment, with a low of 1 or 2 for extreme immaturity to as high as 4 or 5 for postmaturity. The following physical characteristics are assessed:

• skin - ranges from sticky and red to smooth to cracking or peeling
• lanugo (the soft downy hair on a baby's body) is absent in immature babies, then appears with maturity, and then disappears again with postmaturity
• plantar creases - these creases on the soles of the feet range from absent to covering the entire foot depending on the maturity
• breast - the thickness and size of breast tissue and areola (the darkened ring around each nipple) are assessed
• eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue
• genitals, male - presence of testes and appearance of scrotum, from smooth to wrinkled
• genitals, female - appearance and size of the clitoris and the labia

• posture - How does the baby hold his/her arms and legs?
• square window - How much can the baby's hands be flexed toward the wrist?
• arm recoil - How much to the baby's arms "spring back" to a flexed position?
• popliteal angle - How far do the baby's knees extend?
• scarf sign - How far can the elbows be moved across the baby's chest?
• heel to ear - How close can the baby's feet be moved to the ear?

A score is assigned to each assessment area. Typically, the more neurologically mature the baby, the higher the score.

When the physical assessment score and the neuromuscular score are added together, the gestational age can be estimated. Scores range from very low for immature babies (less than 26 to 28 weeks) to very high scores for mature and postmature babies.

All of these examinations are important ways to learn about your baby's well-being at birth. By identifying any problems, your baby's physician can plan the best possible care.