Ballard Score Overview: The Ballard Score assesses the physical and neuromuscular maturity of newborn infants.

Study Parameters: • neuromuscular maturity: 6 parameters • physical maturity: 7 parameters Neuromuscular Maturity 0 posture 1 2 3 4 elbows & legs bent and drawn close to body 0° 5 NA

wrists arms wrists bent elbows hips elbows hips hips and and legs and legs and legs legs straight slightly bent bent but do bent to 90° not reach 90° 90° 60° 45° 30°

square window (wrist) arm recoil popliteal angle scarf sign


180° 180° elbow beyond opposite axillary line

NA 160°

110-180° 130°

90-100° 110° elbow to midline

< 90° 90° elbow to axillary line

NA < 90° NA

elbow to elbow to opposite opposite axillary line midclavicular line

heel to ear

leg straight knee slightly knee bent knee bent to knee bent toes reach bent heel heel reaches 90° heel heel chin reaches 120° from reaches 90° reaches 45° 140° from prone from prone from prone prone Physical Maturity 0 1 2 3 cracking pale areas rare veins bald areas 4 parchment deep cracking no vessels mostly bald creases over entire sole


5 feathery cracked wrinkled NA NA


gelatinous smooth pink superficial red visible veins peeling &/or translucent rash few veins none no crease abundant faint red marks thinning

lanugo plantar surface

anterior creases transverse anterior two crease only thirds

95: 769-774. Week 26 28 30 32 34 36 38 40 42 44 .breast barely perceptible pinna flat stays folded flat areola no bud slightly curved pinna soft with slow recoil NA stippled raised full areola 5 areola 1 mm areola 3 mm mm bud bud bud well-curved pinna soft with ready recoil formed & firm with instant recoil thick cartilage ear stiff NA ear NA genitals male scrotum empty no rugae prominent clitoris & labia minora testes testes down testes descend-ing good rugae pendulous few rugae deep rugae majora & minora equally prominent majora large majora minora cover clitoris small & minora NA genitals female NA NA Ballard Score = = SUM (points for each parametet) Interpretation: • minimum score: 0 • maximum score: 54 Correlation of score with gestational age Score 5 10 15 20 25 30 35 40 45 50 References: Ballard JL Novak KK Driver M. A simplified score for assessment of fetal maturation of newly born infants. J Pediatr. 1979.

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