Newborn Gestational Age Exam

Aka: Newborn Gestational Age Exam, Postnatal Assessment of Gestational Age, New Ballard Score, Ballard Score, Dubowitz Exam, Dubowitz Score

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II. Background: History

  1. New Ballard Score replaces the Dubowitz Score and the original Ballard Scores
  2. Dubowitz Score was based on
    1. Edema
    2. Skin texture, color, and opacity
    3. Lanugo
    4. Plantar creases
    5. Nipples and Breasts
    6. Ear form and firmness
    7. Genitals
    8. Neurologic signs

III. Indications

  1. Newborn Gestational age assessment

IV. Exam: Neuromuscular Maturity Criteria

  1. Posture
    1. Score 0: Fully extended at rest
    2. Score: 4: Fully flexed at rest Square Window
    3. Score -1: Wrist flexion >90 degrees (wrist only partially flexed)
    4. Score 4: Wrist flexion approaches 0 degrees (maximally flexed with the fingers virtually touching the wrist)
  2. Arm Recoil
    1. Description: Elbow briefly extended and then allowed to recoil to flexor rest position
    2. Score 0: No recoil (arms remain extended)
    3. Score 4: Maximal recoil back to flexed elbow Popliteal Angle
    4. Description: Infants thigh is flexed against their Abdomen, then when the infant is relaxed, the knee is extended
    5. Score -1: Full knee extension to 180 degrees (approaching the infants head)
    6. Score 5: Knee remains primarily in flexion (<90 degrees extension)
  3. Scarf Sign
      1. Description: Infants elbow is moved laterally across their chest toward the opposite axilla Score -1: Elbow reaches axilla on the opposite side of chest
    1. Score 4: Elbow minimally crosses the chest Heel To Ear
    2. Description: Infants thigh is hyperflexed (toward their Abdomen and table), and the knee is flexed to bring the foot toward the ear
    3. Score -1: Heel reaches the ear with the knee fully extended
    4. Score 4: Knee remains primarily in flexed position

V. Exam: Physical Maturity Criteria

  1. Skin
    1. Score -1: Skin sticky, friable and transparent
    2. Score 5: Skin leathery, cracked and Wrinkled
  2. Lanugo
    1. Score -1: No Lanugo
    2. Score 1: Abundant Lanugo
    3. Score 4: Mostly bald
  3. Plantar Surface
    1. Score -2: Heel to toe distance <40 mm
    2. Score 0: Heel to toe distance >50 mm and no crease
    3. Score 3: Creases cover the anterior 2/3 of the sole
    4. Score: 4: Crease cover the entire sole
  4. Breast
    1. Score -1: Imperceptable Breast tissue
    2. Score 4: Full areola with 5-10 mm bud
  5. Eye/Ear
    1. Score -2: Eyelids fused tightly
    2. Score 0: Lids open; Ear Pinna flat and stays folded
    3. Score 4: Thick ear cartilage and stiff Ear Pinna
  6. Genitalia (male)
    1. Score -1: Scrotum flat, empty and smooth without rugae
    2. Score 4: Testes pendulous with deep rugae
  7. Genitalia (female)
    1. Score -1: Clitoris prominent and labia flat
    2. Score 4: Labia majora covers clitoris and labia minora

VI. Interpretation

  1. Total Score -10: Gestational age 20 weeks
  2. Total Score 0: Gestational age 24 weeks
  3. Total Score 10: Gestational age 28 weeks
  4. Total Score 20: Gestational age 32 weeks
  5. Total Score 30: Gestational age 36 weeks
  6. Total Score 35: Gestational age 38 weeks
  7. Total Score 40: Gestational age 40 weeks
  8. Total Score 45: Gestational age 42 weeks

VII. Resources

  1. New Ballard Score PDF
    1. http://www.ballardscore.com/files/BallardScore_scoresheet.pdf

VIII. References

  1. Ballard (1991) J Pediatrics 119:417-423 [PubMed]

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