NEW BALLARD

SCORE
BALLARD SCORE

• Method of determining postnatal gestational age

• Criteria:
• Neuromuscular maturity
• Physical maturity
• The score spans from -10 to 50
(correlating with 20 wks to 44 wks
gestation)
• Also called “Dubowitz Maturity Scale”
PROCEDURE

• The examination is administered twice by two different

examiners to ensure objectivity
• The examination consists of two parts : neuromuscular
maturity and physical maturity
• Maturity rating is expressed in weeks of gestation,
estimated by using the chart provided on the form
• The data are entered on the chart
OY HAROLD!!
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NEUROMASCULAR
MATURITY
POSTURE

• Observe the unrestrained infant in the supine position.

SQUARE WINDOW (WRIST)

• Flex the wrist and measure the minimal angel between the ventral
surface of the forearm and the palm.
ARM RECOIL

• With the infant supine and the head midline, hold the forearm against the arm
for 5 seconds, the fully extend and release the arm. Note the time it takes for
the infant to resume a flexed posture
POPLITEAL ANGLE

• Flex the hips with the thigh upon the abdomen. Then, without lifting the hips
from the bad surface, extend the knee as far as possible until resistance is met.
SCARF SIGN

• Again, keeping the head in the midline, pull the hand across the chest to
encircle the neck as a scarf and note the position of the elbow relative to the
midline.
HEAL TO EAR

• with the infant supine and the pelvis kept on the examining surface, the feet are
brought back as far as possible toward the head, allowing the knees to be
positioned alongside the abdomen.
PHYSICAL
MATURITY
SKIN

• With maturation, the skin becomes thicker, less translucent and, eventually, dry
and peeling.
LANUGO

• This fine, nonpigmented hair is evenly distributed over the body and is most
prominent at 27-28 weeks gestation, then it gradually disappears, usually first
from the lower back.
PLANTAR SURFACE

• As with the hands, the presence of creases in the foot is a reflection of

intrauterine activity as well as maturation.
• 32 weeks
gestation :
creases on
one third
of the sole

• 36 weeks
to term
gestation :
creases
over the
majority
of the sole

FOOT SOLE CREASES

BREAST

• The areola development is not dependent on adequacy of intrauterine nutrition.

There is no difference in male or female infants.
 • 28 weeks gestation : No
breast tissue, areola barely
visible

• 32 weeks gestation : visible • 36 weeks gestation : well-defined

areola, little breast tissue areola, breast nodule
EAR CARTILAGE

• With maturation, the cartilage becomes increasingly stiff and the auricle thickens. Fold the top
of the ear and assess the recoil.
• 28 weeks gestation : 36 weeks to term gestation :
firm ear, well-formed margin
little cartilage, pliable
EYELID OPENING
• used (incorrectly) by others as a sign of nonviability.
tight fused as both lids being in separable by gentle traction.
loosely fused as either lid being able to be partly separated by gentle traction.
EXTERNAL GENITALIA, MALE

• Palpate for level of testicular descent and observe the degree of

rogation.
EXTERNAL GENITALIA, FEMALE

• The labia minora and clitoris are prominent in the immature newborn. With
maturation, the labia majora becomes fat-filled and therefore prominent. The
undernourished fetus may have relatively thin labia majora.
 28 weeks gestation 36 weeks to term gestation : testis
well descended, increased scrotal
pigmentation

GENITALIA - MALE
GENITALIA - FEMALE
OY HAROLD!!
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LUBCHENCO
GROWTH
CHARTS
• Classification of newborns by birth weight and gestational
age. The nurse places the newborn’s birth weight and
gestational age on the graph and classifies the newborn as
large for gestational age (LGA), appropriate for gestational
age (AGA), or small for gestational age (SGA).
OY HAROLD!!
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AGAIN