Ballard Maturational Assessment
The Ballard Maturational Assessment, Ballard Score, or Ballard Scale 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 fetus. 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 37 weeks of age) is in a state of physiological hypotonia. This tone increases throughout the fetal growth period, meaning a more premature baby would have lesser muscle tone.
It was developed in 1979.
The neuromuscular criteria
The physical criteria
|-1||0||1||2||3||4||5||Record Score Below:|
|Skin||sticky, friable, transparent||gelatinous, red, translucent||smooth pink, visible veins||superficial peeling &/or rash, few veins||cracking, pale areas, rare veins||parchment, deep cracking, no vessels||leathery, cracked, wrinkled|
|Lanugo||None||Sparse||Abundant||Thinning||Bald areas||Mostly bald||Sparse|
40–50 mm: -1
<40 mm: -2
|Faint red marks||Anterior transverse crease only||Creases over anterior 2/3 of sole||Creases over entire sole|
|Breast||Imperceptible||Barely perceptible||Flat areola
1–2 mm bud
3–4 mm bud
5–10 mm bud
|Eye and Ear||Lids fused
|Sl. curved pinna
soft; slow recoil
soft but ready recoil
|Formed & firm
|Genitals (Male)||Scrotum flat,
|Testes in upper canal,
|Genitals (Female)||Clitoris prominent & labia flat||Prominent clitoris & small labia minora||Prominent clitoris & enlarging minora||Majora & minora equally prominent||Majora large, minora small||Majora cover clitoris & minora|
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)
- Ballard JL, Novak KK, Driver M (November 1979). "A simplified score for assessment of fetal maturation of newly born infants". J. Pediatr. 95 (5 Pt 1): 769–74. doi:10.1016/S0022-3476(79)80734-9. PMID 490248.
- Bedside clinics in pediatrics | author=Sibarjun Ghosh
- Ballard, JL; Khoury, JC; Wedig, K; Wang, L; Eilers-Walsman, BL; Lipp, R (September 1991). "New Ballard Score, expanded to include extremely premature infants.". The Journal of Pediatrics. 119 (3): 417–23. doi:10.1016/s0022-3476(05)82056-6. PMID 1880657. Retrieved 13 August 2012.