Ballard Maturational Assessment

The Ballard Score is a commonly used technique of gestational age assessment. It assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the baby. These criteria are divided into Physical and Neurological criteria. This scoring allows for the estimation of age in the range of 26 weeks-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 that the fetus undergoes during its maturation. Whereas the neurological criteria depend mainly upon muscle tone, the physical ones rely on anatomical changes. The neonate(less than 28 days of age) is in a state of physiological hypertonia. This tone increases throughout the fetal growth period, meaning a more pre-mature baby would have lesser muscle tone.

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The Physical criteria

These are:

1. Skin
2. Ear/Eye
3. Lanugo Hair
4. Plantar Surface
5. Breast Bud
6. Genitals

The Neurological criteria

1. Posture
2. Square Window
3. Arm Recoil
4. Popliteal Angle
5. Scarf sign
6. Heel to Ear

Scoring

Each of the above criteria are scored from 0 through 5, in the original Ballard Score. The scores were then ranged from 5 to 50, with the corresponding gestational ages being 26 weeks and 44 weeks. An increase in the score by 5, increases the 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 to 50, the gestational range extending up to 20 weeks. (A simple formula to come directly to the age from the Ballard Score is Age=(2*score+120) /5)