lecture 4 new ballard score

NEW BALLARD SCORE (NBS)

Dr. I Made Kardana, SpADepartment of Pediatric

Faculty of medicine Udayana University/Sanglah Hospital of Denpasar

Definition Method of determining postnatal

gestational age Criteria:

Neuromuscular maturity Physical maturity

The score spans from -10 to 50 (correlating with 20 wks to 44 wks gestation)

Procedure The examination is administered twice by

two different examiners to ensure objectivity

The examination consists of two parts : neuromuscular maturity and physical maturity

The 12 scores are totaled Maturity rating is expressed in weeks of

gestation, estimated by using the chart provided on the form

The data are entered on the chart

Neuromuscular maturity

1. Posture : Observe the unrestrained infant in the supine position

2. Square window : Flex the wrist and measure the minimal angel between the ventral surface of the forearm and the palm

……neuromuscular maturity

3. Arm Recoil : With the infant supine and the head midline, hold the forearm against the arm for 5 seconds, the fully extend and release the arm. Note the time it takes for the infant to resume a flexed posture

……neuromuscular maturity

4. Popliteal angle : Flex the hips with the thigh upon the abdomen. Then, without lifting the hips from the bad surface, extend the knee as far as possible until resistance is met.

……neuromuscular maturity

5. Scarf sign : Again, keeping the head in the midline, pull the hand across the chest to encircle the neck as a scarf and note the position of the elbow relative to the midline

……neuromuscular maturity

6. Heel to ear : with the infant supine and the pelvis kept on the examining surface, the feet are brought back as far as possible toward the head, allowing the knees to be positioned alongside the abdomen

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Physical maturity

1. Skin : With maturation, the skin becomes thicker, less translucent and, eventually, dry and peeling

…..Physical maturity

1. Lanugo : This fine, nonpigmented hair is evenly distributed over the body and is most prominent at 27-28 weeks gestation, then it gradually disappears, usually first from the lower back.

…..Physical maturity

2. Plantar surface : As with the hands, the presence of creases in the foot is a reflection of intrauterine activity as well as maturation.

Foot sole creases

32 weeks’ gestation :creases in anterior one third

36 weeks’ to term gestation : creases over the majority of the sole

…..Physical maturity

3. Breast : The areola development is not dependent on adequacy of intrauterine nutrition. There is no difference in male or female infants.

28 weeks’ gestation :No breast tissue, areola barely visible

32 weeks’ gestation :visible areola, little breast tissue

36 weeks gestation :well-defined areola, breast nodule

…..Physical maturity

4. Ear cartilage : With maturation, the cartilage becomes increasingly stiff and the auricle thickens. Fold the top of the ear and assess the recoil.

28 weeks” gestation :little cartilago, pliable

36 weeks to term gestation : firm ear, well-formed margin

…..Physical maturity

5. Eyelid opening : use (incorrectly) by some as a sign of nonviability)

- tight fused : as both lids being in separable by gentle traction,

- loosely fused as either lid being able to be partly separated by gentle traction

…..Physical maturity

6. External genitalia, male : Palpate for level of testicular descent and

observe the degree of rugation

External genitalia, female : the labia minora and clitoris are prominent in

the immature newborn. With maturation, the labia majora becomes fat-filled and therefore prominent. The undernourished fetus may have relatively thin labia majora

Genitalia - MaleGenitalia - Male

28 weeks’ gestation :testis high in scrotum

36 weeks to term gestation : testis well descended, increased scrotal pigmentation

Female genitalia

…..procedure

Part 2 of the form is the used to plot gestational assessment against length, weight, and head circumference to determine whether the infant is SGA, AGA, Or LGA. The are the so-called Lubchenco charts.