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DeutschBallard Maturational Assessment
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| 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
[edit]- 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
[edit]| −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
[edit]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
| 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
[edit]References
[edit]- ^ 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.
- ^ "Square Window". ballardscore.com. Retrieved 19 September 2017.
- ^ Bedside clinics in pediatrics | author: Sibarjun Ghosh.
- ^ 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.