Ballard Maturational Assessment

Ballard Maturational Assessment
Synonyms	Ballard Score, Ballard Scale
Purpose	gestational age assessment

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 Pediatrics, Obstetrics and Gynecology at the University of Cincinnati College of Medicine. It was developed in 1979. ^[1]

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. This scoring 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 pre-term babies, i.e., up to 20 weeks.

The scoring relies on the intra-uterine 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 infants posture from flexed to extended
• Square window – assess the flexibility of the wrist ^[2]
• 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 infants arm across their chest
• Heel To ear – note the location of the heel when stretching the infants leg toward ear ^[3]

Physical criteria

Extended physical maturity assessment rubric ^[4]

	−1	0	1	2	3	4	5
Skin	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
Lanugo	none	sparse	abundant	thinning	bald areas	mostly bald	sparse
Plantar surface (Heel–toe)	40–50 mm	>50 mm, no crease	faint red marks	anterior transverse crease only	creases over anterior 2/3 of sole	creases over the entire sole
Breast bud	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
Eye and Ear	lids fused	lids open, pinna flat stays folded	slightly curved pinna, soft, slow recoil	well-curved pinna, soft but ready recoil	formed & firm, instant recoil	thick cartilage, ear stiff
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
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

Scoring system

In the original Ballard Score, each of the criteria is scored from 0 – 5. The scores were then ranged 5 – 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, hence making negative scores possible. The possible scores then range from −10 – 50 with the gestational range extending earlier to 20 weeks.

A simple formula to for age from the Ballard Score is

age = (2 * score + 120) / 5

Maturity Rating

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

See also

• Apgar score

References

1. Ballard JL, Novak KK, Driver M (November 1979). "A simplified score for assessment of fetal maturation of newly born infants". J. Pediatr. 95 (5 Pt 1): 769–74. doi:10.1016/S0022-3476(79)80734-9. PMID   490248.
2. "Square Window". ballardscore.com. Retrieved 19 September 2017.
3. Bedside clinics in pediatrics | author: Sibarjun Ghosh.
4. Ballard, JL; Khoury, JC; Wedig, K; Wang, L; Eilers-Walsman, BL; Lipp, R (September 1991). "New Ballard Score, expanded to include extremely premature infants". The Journal of Pediatrics. 119 (3): 417–23. doi:10.1016/s0022-3476(05)82056-6. PMID   1880657 . Retrieved 13 August 2012.

External links

• BallardScore.com