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Newborn Gestational Age Exam
Aka: Newborn Gestational Age Exam, Postnatal Assessment of Gestational Age, New Ballard Score, Ballard Score, Dubowitz Exam, Dubowitz Score
- See Also
- Fetal Growth
- Small for Gestational Age
- Intrauterine Growth Retardation
- Fetal Macrosomia (Large for Gestational Age)
- Background: History
- New Ballard Score replaces the Dubowitz Score and the original Ballard Scores
- Dubowitz Score was based on
- Edema
- Skin texture, color, and opacity
- Lanugo
- Plantar creases
- Nipples and Breasts
- Ear form and firmness
- Genitals
- Neurologic signs
- Indications
- Newborn Gestational age assessment
- Exam: Neuromuscular Maturity Criteria
- Posture
- Score 0: Fully extended at rest
- Score: 4: Fully flexed at rest
Square Window
- Score -1: Wrist flexion >90 degrees (wrist only partially flexed)
- Score 4: Wrist flexion approaches 0 degrees (maximally flexed with the fingers virtually touching the wrist)
- Arm Recoil
- Description: Elbow briefly extended and then allowed to recoil to flexor rest position
- Score 0: No recoil (arms remain extended)
- Score 4: Maximal recoil back to flexed elbow
Popliteal Angle
- Description: Infants thigh is flexed against their Abdomen, then when the infant is relaxed, the knee is extended
- Score -1: Full knee extension to 180 degrees (approaching the infants head)
- Score 5: Knee remains primarily in flexion (<90 degrees extension)
- Scarf Sign
- Description: Infants elbow is moved laterally across their chest toward the opposite axilla
Score -1: Elbow reaches axilla on the opposite side of chest
- Score 4: Elbow minimally crosses the chest
Heel To Ear
- Description: Infants thigh is hyperflexed (toward their Abdomen and table), and the knee is flexed to bring the foot toward the ear
- Score -1: Heel reaches the ear with the knee fully extended
- Score 4: Knee remains primarily in flexed position
- Exam: Physical Maturity Criteria
- Skin
- Score -1: Skin sticky, friable and transparent
- Score 5: Skin leathery, cracked and Wrinkled
- Lanugo
- Score -1: No Lanugo
- Score 1: Abundant Lanugo
- Score 4: Mostly bald
- Plantar Surface
- Score -2: Heel to toe distance <40 mm
- Score 0: Heel to toe distance >50 mm and no crease
- Score 3: Creases cover the anterior 2/3 of the sole
- Score: 4: Crease cover the entire sole
- Breast
- Score -1: Imperceptable Breast tissue
- Score 4: Full areola with 5-10 mm bud
- Eye/Ear
- Score -2: Eyelids fused tightly
- Score 0: Lids open; Ear Pinna flat and stays folded
- Score 4: Thick ear cartilage and stiff Ear Pinna
- Genitalia (male)
- Score -1: Scrotum flat, empty and smooth without rugae
- Score 4: Testes pendulous with deep rugae
- Genitalia (female)
- Score -1: Clitoris prominent and labia flat
- Score 4: Labia majora covers clitoris and labia minora
- Interpretation
- Total Score -10: Gestational age 20 weeks
- Total Score 0: Gestational age 24 weeks
- Total Score 10: Gestational age 28 weeks
- Total Score 20: Gestational age 32 weeks
- Total Score 30: Gestational age 36 weeks
- Total Score 35: Gestational age 38 weeks
- Total Score 40: Gestational age 40 weeks
- Total Score 45: Gestational age 42 weeks
- Resources
- New Ballard Score PDF
- http://www.ballardscore.com/files/BallardScore_scoresheet.pdf
- References
- Ballard (1991) J Pediatrics 119:417-423 [PubMed]