Dubowitz法

Neuromuscular Maturity

• Posture: With the infant supine and quiet, score as follows:
  • Arms and legs extended = 0
  • Slight or moderate flexion of hips and knees = 1
  • Moderate to strong flexion of hips and knees = 2
  • Legs flexed and abducted, arms slightly flexed = 3
  • Full flexion of arms and legs = 4
• Square Window: Flex the hand at the wrist. Exert pressure sufficient to get as much flexion as possible. The angle between the hypothenar eminence and the anterior aspect of the forearm is measured and scored:
  • >90 degrees = -1
  • 90 degrees = 0
  • 60 degrees = 1
  • 45 degrees = 2
  • 30 degrees = 3
  • 0 degrees = 4
• Arm Recoil: With the infant supine, fully flex the forearm for 5 seconds, then fully extend by pulling the hands and release. Score the reaction:
  • Remains extended 180 degrees, or random movements = 0
  • Minimal flexion, 140-180 degrees = 1
  • Small amount of flexion, 110-140 degrees = 2
  • Moderate flexion, 90-100 degrees = 3
  • Brisk return to full flexion, <90 degrees = 4
• Popliteal Angle: With the infant supine and the pelvis flat on the examining surface, the leg is flexed on the thigh and the thigh fully flexed with the use of one hand. With the other hand the leg is then extended and the angled scored:
  • 180 degrees = -1
  • 160 degrees = 0
  • 140 degrees = 1
  • 120 degrees = 2
  • 100 degrees = 3
  • 90 degrees = 4
  • <90 degrees = 5
• Scarf Sign: With the infant supine, take the infant's hand and draw it across the neck and as far across the opposite shoulder as possible. Assistance to the elbow is permissible by lifting it across the body. Score according to the location of the elbow:
  • Elbow reaches or nears level of opposite shoulder = -1
  • Elbow crosses opposite anterior axillary line = 0
  • Elbow reaches opposite anterior axillary line = 1
  • Elbow at midline = 2
  • Elbow does not reach midline = 3
  • Elbow does not cross proximate axillary line = 4
• Heel to Ear: With the infant supine, hold the infant's foot with one hand and move it as near to the head as possible without forcing it. Keep the pelvis flat on the examining surface. Score as shown in the diagram above.