Do Parents Know What the Ballard Score Is ?Ballard scoreor Ballard score is one of the physical examinations on newborns. The purpose of this test is to determine gestational age or the time period between conception and delivery.
To find out what the Ballard score is, its function, and how to determine it, see the complete information below.
What is Ballard Score?
Quoting from the National Center for Biotechnology Information , the Ballard score is carried out to test validity, accuracy, reliability and postnatal age.
In the calculationNew Ballard Score(NBS), scores were generated for 578 newborns and the results were analyzed.
Gestational age ranged from 20 to 44 weeks and postnatal age at examination ranged from birth to 96 hours.
In 530 infants, gestational age based on the last menstrual period was confirmed by agreement within 2 weeks with gestational age by prenatal ultrasonography (C-GLMP).
Ballard Score Function
Inspection functionballard scoreis to determine the gestational age of a newborn. This ballard score is done by conducting physical and neuromuscular assessments.
Physical maturity examination includes:
1. Skin Examination
Along with the gradual loss of its protective layer,vernix caseosa, the fetus’s skin undergoes maturation which involves the development of the structure of the organs in the body.
Therefore, the skin will thicken, dry out, and become wrinkled and/or flaky, and may develop a rash as fetal maturation progresses.
The Ballard score for skin examination is as follows:
- Transparent, sticky, fragile skin (-1)
- Translucent, red, gelatinous skin (0)
- Soft/slippery, veins visible, pink (1)
- Multiple veins, superficial peeling skin and/or rash (2)
- Veins are sparse, skin is cracked, there are pale areas (3)
- No visible veins, deep cracked skin, parchment (4)
- Cracked and wrinkled (5)
2. Lanugo
Lanugo is fine hair that covers the fetus’ body. It usually begins to appear around week 24 to 25, especially on the shoulders and upper back, at week 28 of pregnancy.
- Lanugo absent (-1)
- Lanugo is very rare (0)
- Lots of (1)
- Looks thin (2)
- Presence of several hairless areas (3)
- Mostly hairless (4)
3. Plantar Line
This is the first line of the sole of the foot that appears on the anterior part. This is probably related to the position when the baby was in the womb.
Usually, premature and very premature babies do not have a foot line. Scoreballardfrom this examination are:
- Heel-to-toe <40 mm (-2)
- Heel-to-toe 45-50 mm (-1)
- >50 mm, no creases (0)
- There is a thin red line (1)
- There is a transverse line on the anterior part (2)
- Crease line up to 2/3 anterior (3)
- Whole palm crease lines (4)
4. Breasts
The areola consists of breast tissue that is stimulated by the mother’s estrogen hormone . This also occurs because the fat tissue depends on the nutrition the fetus gets while in the womb.
- Areola cannot be assessed/Impossible(-1)
- Hard to judge/barely perceptible(0)
- Flat shaped, no protrusions / no buds (1)
- Bumpy shape, protrusion of the areola about 1-2 mm (2)
- Areola is raised, protrusion is about 3-4 mm (3)
- Full areola, areola protrusion is around 5-10 mm (4)
5. Eyes/Ears
Assessment includes palpation to determine the thickness of the ear cartilage, then folding the earlobe forward toward the face and releasing it.
This examination is carried out to see maturity based on the development of the eyelids.
- Sticky eyelids/lightly fused(-2)
- Loosely fused eyelids/loosely fused(-1)
- Flat earlobes, open eyelids, remain folded (0)
- Minimal pinna environment, soft, slow recoil (1)
- Good pinna curvature, soft, ready to recoil (2)
- Firm, hard shape, immediate recoil (3)
- Thick, stiff cartilage (4)
6. Genitalia of Baby Boys (L) and Girls (P)
Ballard’s scoring assessment is as follows:
- L: Flat, smooth scrotum (-1); P: Prominent clitoris, flat labia (-1)
- L: Scrotum empty, rugae faint (0); P: Prominent clitoris, small labia minora (0)
- L: Testes in upper canal, rugae sparse (1); P: Clitoris prominent, labia minora enlarged (1)
- L: Testes descended, few rugae (2); P: Labia majora and minora prominent (2)
- L: Testes descended, rugae evident (3); P: Labia majora large, labia minora small (3)
- L: Pendulum testis, deep rugae (4); P: Labia majora covering the clitoris and labia minora (4)
Neuromuscular maturity testing includes:
1. Posture
This assessment looks at how the body’s muscle tone is reflected in the baby’s posture when resting and when there is resistance when the muscles are stretched.
2. Square window
This examination is seen by straightening the fingers and pressing the back of the hand close to the fingers. Also, looking at the flexibility of the wrist to the extensor stretch.
3. Arm recoil
This assessment is done when the baby is lying on his back. The method is to hold both of the baby’s hands, stretch the lower arms as far as possible in 5 seconds, then stretch both arms and release.
Observe how the baby reacts when the arm is released. Here are the scores:
- 0: hands remain outstretched/random movements.
- 1: partial flexion 140-180 degrees
- 2: partial flexion 110-140 degrees
- 3: partial flexion 90-100 degrees
- 4: return to full flexion
4. Popliteal angle
This is done to assess the maturation of passive flexor tone about the knee joint by testing resistance to extension of the lower extremity.
5. Scarf sign
This test tests the passive tone of the flexors in the shoulder girdle. The infant lies supine, the examiner adjusts the infant’s head to the midline and supports the infant’s hand on the upper chest with one hand. The thumb of the examiner’s other hand is placed on the infant’s elbow.
The examiner touches the elbow to the chest, flexing for passive flexion or resistance to extension of the posterior shoulder girdle flexor muscles.
6. Heel to ear
This maneuver measures passive flexor tone about the pelvic girdle by testing passive flexion or resistance to extension of the posterior hip flexor muscles.
Understanding Gestational Age
Close-up face of newborn Asian baby in the blanket.
Gestational age is defined as the number of weeks between the first day of the mother’s last normal menstrual period and the day of delivery. More precisely, gestational age is the difference between 14 days before the date of conception and the day of delivery.
This age is not the actual embryological age of the fetus, but is a universal standard among obstetricians and neonatologists to discuss fetal maturation.
Meanwhile, embryological age is the time from the date of conception to the date of delivery and is less than 2 weeks from the gestational age.
Pregnant women can estimate their conception date based on their ovulation time as identified by hormonal testing.
Estimated gestational age can be based on:
- Date of conception
- First day of last period and cycle length
- Fetal ultrasound
- Physical parameters after birth (e.g., using the Ballard score)
Physical examination findings of the newborn allow the doctor to estimate gestational age using the new Ballard score.
The Ballard score is based on the physical and neuromuscular maturity of the neonate and can be used up to 4 days after birth (in practice, the Ballard score is usually used within the first 24 hours).
The neuromuscular component is more consistent over time because the physical component matures rapidly after birth. However, the neuromuscular component can be affected by disease and medications (eg, magnesium sulfate given during labor).
Because the Ballard score is accurate only to within plus or minus 2 weeks, it should be used to determine gestational age only when there is no reliable obstetric information about the estimated date of delivery, or there is a large discrepancy between the obstetrically determined gestational age and the gestational age.
How to Determine Gestational Age with Ballard Score
Scores are given for each assessment area. Typically, the more neurologically mature the baby, the higher the score.
When the physical assessment scores and neuromuscular scores are added together, gestational age can be estimated. Scores range from very low for immature infants (less than 26 to 28 weeks) to very high for mature and postmature infants.
However, these scores may not be accurate in premature infants with very low birth weight (birth weight less than 1500 grams).
The Ballard score can estimate gestational age from 20 weeks to 44 weeks. The interpretation of the Ballard score results is as follows:
- -10 = 20 weeks old
- -5 = 22 weeks old
- 0 = 24 weeks old
- 10 = 28 weeks old
- 15 = 30 weeks old
- 20 = 32 weeks old
- 25 = 34 weeks old
- 30 = 36 weeks old
- 35 = 38 weeks old
- 40 = 40 weeks old
- 45 = 42 weeks old
- 50 = 44 weeks old
Meanwhile, in premature babies or preterm neonates (NKB), the assessment can be classified based on gestational age as follows:
- Moderate premature babies: gestational age 32-37 weeks
- Premature: gestational age 28-32 weeks
- Extreme prematurity: gestational age <28 weeks
Parents, all of these tests are important ways to learn about your little one’s health at birth. Identifying any problems will help your doctor plan the best possible care.
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Republished with permission from theAsianparent Indonesia
