Assessment of gestational age by examination of the anterior vascular capsule of the lens

doi:10.1016/S0022-3476(77)81324-3

The Journal of Pediatrics

Volume 91, Issue 3, September 1977, Pages 455-458

https://doi.org/10.1016/S0022-3476(77)81324-3 Get rights and content

The disappearance of the anterior vascular capsule of the lens (pupillary membrane) was found to be useful in the preterm infant to estimate accurately gestational age between the twenty-seventh and the thirty-fourth weeks. Before the twenty-seventh week, the cornea was too opaque to allow good visualization of this vascular system. After the thirty-fourth week, these vessels had generally atrophied completely. One hundred infants between 27 and 34 weeks' gestational age as assessed by the Dubowitz scoring system were studied with the direct ophthalmoscope following dilatation of the pupil. Disappearance of the anterior vascular capsule was arbitrarily divided into four grades. The correlation between gestational age and the grade of anterior vascular capsule was found to be highly significant (p<0.001).

References (3)

DubowitzLMS et al.
Clinical assessment of gestational age in the newborn infant
J Pediatr
(1970)

There are more references available in the full text version of this article.

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Citation Excerpt :
According to Sherer [20,21], the age of gestation of a neonatal cadaver can also be determined by measuring the length of the clavicle, but this has not yet been investigated in a forensic setting. In preterm infants, an examination of the anterior vascular capsule of the lens can also give information on gestational age [22]. It could be speculated that this examination method is also possible in newborn fresh cadavers.
Signs of maturity such as weight, length and head circumference are still a measure used to investigate cases of suspected neonaticides as they help to differentiate between newborns born dead or alive. However, limit values for these signs have not changed for a long time. Our study considers whether limit values should have changed and which validity the current ones have. We investigated the cases of 3162 newborns, dividing them into a mature and an immature collective on the basis of the gestational week. Application of these signs of maturity (2500 g, 48 cm, 34 cm) had a high predictive value concerning maturity (>99%), and even applying only one sign of maturity gave a predictive value over 97%.
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  Neonatologists have both a clinical and a medicolegal responsibility to arrange timely diagnostic retinopathy of prematurity examinations for preterm babies in the neonatal intensive care unit and to communicate to parents the vital importance of keeping outpatient ophthalmology appointments.
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  “Early visual experience drives the architecture of the visual brain.”
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  Screening eye examinations are important in all infants, regardless of gestational age. All neonates should have an examination of the red reflex before discharge from the newborn nursery.
- •
  The absence of visual responsiveness by 2 months of age should prompt an urgent ophthalmologic evaluation.
- •
  Most full-term infants establish normal ocular alignment within the first 2 months.
- •
  Nystagmus can be a manifestation of a congenital motor entity, secondary to visual pathway defects or neurologic disease. Nystagmus caused by defective vision does not develop until approximately 3 months of age.
- •
  Successful treatment of congenital cataracts is highly dependent on early diagnosis and prompt referral.
- •
  The successful management of retinoblastoma depends on the ability to detect the disease while it is still intraocular; disease stage correlates with delay in diagnosis.
- •
  Neonatologists have both a clinical and a medicolegal responsibility to arrange timely diagnostic retinopathy of prematurity examinations for preterm babies in the neonatal intensive care unit and to communicate to parents the vital importance of keeping outpatient ophthalmology appointments.
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^†: Supported by a grant from the Retina Research Foundation, Houston, Texas.

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Assessment of gestational age by examination of the anterior vascular capsule of the lens†

J Pediatr