Professional Documents
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Gestational Age
By
➢Definition
➢Estimation of gestational age
➢Definition of the New Ballard Score
➢Ballard Exam
➢Procedure of gestational age assessment
DR. ATYAT
Definition of gestational age
• Number of weeks that have elapsed since the
first day of the last menstrual period to the
time of birth
DR. ATYAT
Estimation of gestational age
– Physical and neuromuscular examination
– L.M.P.
– Lab test
– Obstetric history
– Fetal ultrasonic
DR. ATYAT
Definition of the New Ballard Score
• The New Ballard Score is a set of procedures developed
by Dr. Jeanne L Ballard, MD to determine Gestational
Age through neuromuscular and physical assessment of
a newborn fetus.
• Ballard Exam
• Focuses on physical and neuromuscular characteristics
Getting Ready
1. Perform hand hygiene before patient contact.
2. Verify the correct newborn using two
identifiers.
3. If moving the newborn to a radiant warmer for
examination, preheat it and apply clean linen.
DR. ATYAT
4.Place the newborn on the radiant warmer or in an
incubator/Isolette. Undress the newborn and apply
temperature probe with reflective disk to the proper
location.
5.Provide comfort measures as needed.
6.Collect supplies and place a copy of the New Ballard
Score (NBS) tool at the bedside.
7.Obtain an NBS documentation sheet and follow the
order of assessment detailed there.
DR. ATYAT
1. Posture
NEURO-MUSCULAR MATURITY SCORE
SIGN SIGN
SCORE
-1 0 1 2 3 4 5
Posture
❖ Observe posture while the newborn is supine and quiet. Remove positioning aids if
necessary. Newborns delivered in the breech position typically have extended legs.
Resting posture is hypotonic in newborns of very early gestation.
DR. ATYAT
2. Square Window
NEURO-MUSCULAR MATURITY SCORE
SIGN SIGN
SCORE
-1 0 1 2 3 4 5
Square
Window
Arm
Recoil
❖ Test arm recoil. Hold the newborn's arms fully flexed for 5 seconds, then fully
extend them by pulling the hands down to the sides, and release quickly.
DR. ATYAT
4. Popliteal Angle
NEURO-MUSCULAR MATURITY SCORE
SIGN
SIGN
-1 0 1 2 3 4 5 score
Popliteal
Angle
Scarf
Sign
Heel
To Ear
❖ Assess skin for color, thickness, texture, and visibility of the veins, particularly on the
DR. ATYAT
abdomen.
2. Lanugo
❖ Assess lanugo (body hair), first on the face and anterior trunk, then on the rest of the body.
DR. ATYAT
3. Plantar Surface
PHYSICAL MATURITY SCORE SIGN
SIGN
-1 0 1 2 3 4 5 SCORE
anterior
creases
heel-toe faint transvers
Plantar >50 creases over
40-50mm: -1 red e
Surface no crease ant. 2/3 entire
<40mm: -2 marks crease
sole
only
Genital scrotu
m
scrotum testes in
empty, upper
testes
descendin
testes
down,
testes
pendulous,
s flat, faint canal, g, good deep
(Male) smooth rugae rare rugae few rugae rugae rugae
DR. ATYAT
DR. ATYAT
DR. ATYAT
Maturity Rating
TOTAL SCORE
WEEKS
(NEUROMUSCULAR + PHYSICAL)
-10 20
-5 22
0 24
5 26
10 28
15 30
20 32
25 34
30 36
35 38
40 40
45 42
50 DR. ATYAT 44
After the Procedure
1. Return the newborn to the mother or original bed
if moved for the assessment.
2. Add the scores and obtain the estimated GA from
the chart on the NBS sheet.
3. Monitor a preterm newborn closely for signs of
temperature instability and overstimulation.
4. Assess, treat, and reassess pain.
5. Perform hand hygiene.
6. Document the procedure in the newborn's record.
DR. ATYAT
ALERT
All newborns should have a gestational age (GA)
assessment, although it should be considered only an
estimate. Several factors, including maternal medical
issues, maternal medication and drug use, newborn
neurologic disorders, and newborn positional
deformities can influence the examination results.
DR. ATYAT
DR. ATYAT