GOVERNMENT COLLEGE OF NURSING,

JODHPUR (RAJ.)

Ballard Scoring

Subject- Pediatrics Nursing

SUBMITTED TO - SUBMITTED BY-

Mrs. Seena p. nair Ashish Kumar Yadav
NURSING LECTURER M.sc (N) Pre. year
GCON, Jodhpur GCON, Jodhpur
Batch-2020

Date of Presentation:-
Date of Submission:-

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 BALLARD SCORING:

INTRODUCTION:

A method to determine the gestational age is New Ballard Scale(NBS).

It was proposed by Dr. Jenne L Ballard in 1991.
New Ballard Scale assessment 6 external physical and 6 neuromuscular signs of
maturity.
Assessment of gestational age from 20 to 44 weeks.
Score range from -10 to +50.
Optimal time for assessment if from birth to 90 hours.

GESTATIONAL AGE ASSESSMENT:

Gestational age can be assessed by three methods-

1. Menstruation history

2. Prenatal ultrasonography

3. Postnatal maturation examination

TERMINOLOGIES:

Gestational age:- Gestational age is the common term used during pregnancy to
describe how far along the pregnancy is. It is measured in weeks, from the first
day of the woman's last menstrual cycle to the current date.

Embryologic age:- Embryologic age is the time elapsed from the date of
conception to the date of delivery and is 2 weeks less than the gestational age.
Women may estimate the date of conception based on their time of ovulation as

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identified by in-home hormonal testing and/or basal body temperature
measurements.

Pre term:- A birth that occurs before the 37th week of pregnancy.

Post term:- Post term is defined as pregnancy that has extended to or beyond 42
weeks of gestation.

Neonate:- A neonate is also called a newborn. The neonatal period is the first 4
weeks of a child's life.

Hypotonia:- Weak muscle tone.

Vernix caseosa:- Vernix caseosa is a white, creamy, naturally occurring biofilm

covering the skin of the fetus during the last trimester of pregnancy. Vernix
coating on the neonatal skin protects the newborn skin and facilitates extra-
uterine adaptation of skin in the first postnatal week if not washed away after
birth.

Flexion:- Flexion is the medical term for bending an arm or leg. It occurs when
muscles contract and move your bones and joints into a bent position. it's a
physical position that decreases the angle between the bones of the limb at a
joint.

Extension:- Extension is the action that increases the angle between the two
bones.

Adduction:- Adduction is a movement towards the midline.

Abduction:- Abduction is a movement away from the midline.

Meconium:- Meconium is a newborn's first poop. This sticky, thick, dark green
poop is made up of cells, protein, fats, and intestinal secretions, like bile.

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Newborn assessment:
Assessment of newborn can can be divided into four phases:-

1. Initial assessment
2. Transitional assessment
3. Gestational age assessment
4. Systemic physical examination

GESTATIONAL AGE ASSESSMENT:

Gestational age is the estimated age of fetus weeks calculated from the first day of
the last menstruation period.
Based on gestational age, each neonate is classified as-

Pre term- <37 weeks

Term- 39 to 41 weeks

Post term - >42 weeks

NEUROMUSCULAR MATURITY:

- Posture
- Square window

- Arm recoil

- Popliteal angle

- Scarf sign

- Heel to ear

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POSTURE:
Observe in the supine position at rest.
Score is assigned based on the degree of flexion of arms, knees and hips.
Increased flexion and hip adduction with increased gestational age.

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SQUARE WINDOW:
Infants hand is fixed on the forearm between the the thumb and index finger of the
examiner.
Apply enough pressure to get full flexion without rotating the wrist.
Angle between the the forum and the palm is measured.

ARM RECOIL:
This maneuver focuses on passive flexor tone of the biceps muscle by measuring
the angle of recoil following very brief extension of the upper
extremity.
Flex the units arms four five seconds while in the supine position.
Fully extend the arms by pulling on the hands and release.
The degree of ARM flexion and strength of recoil are measured. Full term can flex
hand completely up to face.

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POPLITEAL ANGELE:

Place infant in supine position with the pelvis on the mattress.

Using the thumb and index finger of the one hand, examiner
who is the ne adjacent to the chest and abdomen.
Gently extent the leg with the index finger.
Look at the angle between the lower leg, thigh and posterior
knee.

SCARF SIGN:
Place infant in supine position with head in midline position.
Grasp the infant and and pull the arm across the chest and around the neck.
Look at the relationship of elbow two midline of body when arm pulls across the
chest.

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HEEL TO EAR:
Place the infant supine with pelvis flat on table.
Grasp 1 foot with thumb and index finger and drop foot as near to head as possible.
Note the distance between the the foot and head as well as degree of knee is
extension.

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PHYSICAL MATURITY:
-Skin
-Lanugo
-Planter surface
-Breast
-Eye/Ear
-Genitalia

SKIN:
Less transparent and tougher with increasing gestational age.
36-37 weeks loses transparency and underlying vessels are no longer visible.
Increasing gestational age the veins become less viable and increasing
subcutaneous tissue.

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LANUGO:
Fine downy hair covering fetus from 20-28 weeks.
Disappears around face and anterior trunk -28 weeks.
Term infants may have a few a change over shoulders.

PLANTER SURFACE:
28-30 weeks appear and cover the anterior portion of the plantar surface of the
foot.
Exchange to extend toward the heel age increases gestational age.
After 12 hours sole quizzes are not valid indicator of gestational age due to drying
of the skin.

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BREAST:
Areola is raised by 34 weeks.
A 1-2 mm nodules of breast tissue is palpable by 36 weeks.
By 40 weeks the module is 10mm.

EYE/EAR:

Lids are open and complete eyelashes develops at term.

Incurving of the upper pinna begins by 34 weeks gestation and extend entire lobe
by 40 weeks.
Before 34 weeks, pinna has very little cartilage (Stays folded on itself).
At 36 weeks, there is some cartilage and will spring back.

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GENITALIA (MALE):
Testes begin to decend from abdomen around 28 weeks.
At 37 weeks, testes can be palpated high in scrotum.
At 40 weeks, testes are completely descended and covered with rugae.
As gestation progresses, scrotum becomes more pendulous.

GENITALIA (FEMALE):
Early gestation, clitoris prominent and widely separated labia.
By 40 weeks, fat deposits have increased in size in labia majora so labia minora are
completely covered.

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SUMMARY:
The Ballard Scoring or Ballard Scale is a commonly used to techque of
gestational age assessment.
This scoring allows for the estimation of age in the range of 26-44 weeks.
The New Ballard Score is an extension of the above to include extremely preterm
babies that is is upto 20 weeks.

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BIBLIOGRAPHY:-
1. Wong's, Essential of Pediatrics Nursing, MOSBY Publishers, 8th Edition, 2008.

2. Ghai, Essential of Pediatrics Nursing, CBS Publishers, 7th Edition, 2008.

3. Gupte, The Short Textbook of Pediatrics, JAYPEE BROTHERS PUBLISHERS, 11th

Edition, 2009.

4. Piyush, Essential of Pediatrics Nursing, CBS PUBLISHERS, 3rd Edition, 2011.

5. www.slideshare.net.

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