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Ballard Maturational Assessment

Field	Value
name	Ballard maturational assessment
purpose	Gestational age assessment
synonyms	Ballard score, Ballard scale

The Ballard maturational assessment, Ballard score, or Ballard scale, is a gestational age assessment technique. It was devised by Dr. Jeanne L. Ballard, professor emeritus of the Department of Pediatrics, Obstetrics, and Gynecology at the University of Cincinnati College of Medicine. It was developed in 1979.

The assessment scores various criteria, the sum of which is then extrapolated to the gestational age of the fetus. These criteria are divided into physical and neuromuscular criteria, which allows for the estimation of age in the range of 26 weeks to 44 weeks. The new Ballard score is an extension of the above to include extremely preterm babies, i.e., up to 20 weeks.

The scoring relies on the intrauterine changes the fetus undergoes during maturation. Whereas the neuromuscular criteria depend mainly upon muscle tone, the physical scale relies on anatomical changes. Neonate fetuses (less than 37 weeks of age) are in a state of physiological hypotonia, and since muscle tone increases throughout the fetal growth period, it can be used to identify fetal maturation.

Neuromuscular criteria

Posture – score the infant's posture from flexed to extended
Square window – assess the flexibility of the wrist
Arm recoil – measure the angle of recoil after extending arm
Popliteal angle – measure the angle formed between knees during flexed extension
Scarf sign – record the resistance while stretching the infant's arm across the chest
Heel to ear – note the location of the heel when stretching the infant's leg toward the ear

Physical criteria

−1	0	1	2	3	4	5
(Heel–toe)	Breast bud	Eye and ear	Genitals (male)	Genitals (female)
sticky, friable, transparent	gelatinous, red, translucent	smooth pink, visible veins	superficial peeling and/or rash, few veins	cracking, pale areas, rare veins	parchment, deep cracking, no vessels	leathery, cracked, wrinkled
none	sparse	abundant	thinning	bald areas	mostly bald	sparse

40–50 mm	50 mm,
no crease	faint red marks	anterior transverse crease only	creases over anterior two-thirds of sole	creases over the entire sole
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
lids fused	lids open,
pinna flat
stays folded	slightly curved pinna,
soft, slow recoil	well-curved pinna,
soft but ready recoil	formed and firm,
instant recoil	thick cartilage,
ear stiff
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
clitoris prominent and labia flat	prominent clitoris and small labia minora	prominent clitoris and enlarging labia minora	labia majora and minora equally prominent	labia majora large, labia minora small	labia majora cover clitoris and minora

Scoring system

In the original Ballard score, each of the criteria is scored from 0 to 5. The scores were then ranged 5 to 50, with the corresponding gestational ages being 26 weeks and 44 weeks. A score increase of 5 advances the estimated age by 2 weeks. The new Ballard score allows scores of −1 for the criteria. The possible scores then range from −10 to 50, with the gestational range extending earlier to 20 weeks.

A simple formula to estimate age from the Ballard score is age = (2 * score + 120) / 5

Score	Weeks
-10	20
-5	22
0	24
10	28
15	30
20	32
25	34
30	36
35	38
40	40
45	42
50	44

References

(November 1979). "A simplified score for assessment of fetal maturation of newly born infants". J. Pediatr..
"Square Window".
Bedside clinics in pediatrics. author: Sibarjun Ghosh.
Ballard, JL. (September 1991). "New Ballard Score, expanded to include extremely premature infants.". The Journal of Pediatrics.

Info: Wikipedia Source

This article was imported from Wikipedia and is available under the Creative Commons Attribution-ShareAlike 4.0 License. Content has been adapted to SurfDoc format. Original contributors can be found on the article history page.

neonatology medical-scales medical-terminology medical-assessment-and-evaluation-instruments

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