Ballardscore

assessment of gestational age

1. Ballard score By Ms.ULFAT AMIN Tutor SMMCNMT

2. INTRODUCTION A frequently used method of determining gestational age is the New Ballard Scale (NBS) by Ballard, Khoury , Wedig , et al (1991 ). This scale , assesses six external physical and six neuromuscular signs. Each sign has a number score, and the cumulative score correlates with a maturity rating of 20 to 44 weeks of gestation.

3. NEURO MUSCULAR MATURITY

4. 1.POSTURE : Observe posture with infant not crying and in supine position . Arms and legs are extended in preterms , while full flexion of arms and legs is seen in term babies . Term baby has universal flexion (full flexion of arms and legs); very preterm baby of 28 weeks or less will have less flexor tone, and thus both upper and lower limbs remain extended .

5. 1.POSTURE : By around 32 weeks, baby has flexion of lower limbs but upper limbs still remain largely extended. By 36 weeks, both upper and lower limbs have less flexor tone, almost like a term baby.

6. 1 .POSTURE :

7. 2. SQUARE WINDOW TEST : Baby's hand is flexed on the forearm between the thumb and index finger of the examiner with reasonable pressure . Measure the angle between the hypothenar eminence and the ventral aspect of the forearm. In full-term babies, the hypothenar eminence touches the fore arm and hence the angle is nearly zero. In the extreme preterm, it is less malleable, and the angle may be as much as 90°

8. 3.ARM RECOIL Keep the infant in the supine position; flex the fore arms for 5 sec, then fully extend it by pulling on the hands, and then release. The sign is fully positive if the arms return briskly to full flexion (i.e., in full-term babies, the arm recoils fully, which means the angle that forearm makes with the arm will be less than 90°). If the arms return to in complete flexion or the response is sluggish, it is graded accordingly as per chart. They will remain extended without recoiling in extreme pre-terms . https:// www.youtube.com/watch?v=97I03A8eg_Y

9. 4 . POPLITEAL ANGLE : Keep the infant supine and the pelvis flat on the examining couch. Hold the thigh in the knee-chest position using the left index finger and thumb to support the knee. Extend the leg by gentle pressure from your right index finger behind the ankle and measure the angle. Compare angle with the standard charts. In term babies, the angle is less than 90°. In extreme preterm babies, it may be as much as 180 https:// youtu.be/zCcoGGzacUk

10. 5 . SCARF SIGN : With the infant in supine position, take the infant's hand and try to put it across the chest as far as possible towards the opposite shoulder. This manoeuvre will need lifting the elbow across the body. See how far the elbow goes across and grade it as per chart. Elbow will not cross the midline in term babies

11. Landmarks noted in order of increasing maturity: Full scarf at the level of the neck (-1) Contralateral axillary line (0) Contralateral nipple line (1) Xyphoid process (2) Ipsilateral nipple line (3) ipsilateral axillary line (4 ) https:// youtu.be/Lx_4DglwmIE

12. 6 . HEEL TO EAR : With the infant lying supine, pull the infant's foot as near to the head as it will go without forcing it. Observe the distance between the foot and the head as well as the degree of extension at the knee .

13. Landmarks noted in order of increasing maturity include resistance felt when the heel is at or near: – ear (-1) nose (0) chin level (1) nipple line (2) umbilical area (3) femoral crease (4 ) https:// youtu.be/TpKAGbj-H3w

14. PHYSICAL MATURITY

15. 1 . SKIN:

16. 2 . LANUGO : Fine hair covering the body of the fetus. In extreme immaturity, the skin lacks any lanugo. Begins to appear at approximately 24th to 25th week. Abundant, especially across the shoulders and upper back by the 28th week of gestation. At term, most of the fetal back is devoid of lanugo .

17. 3 . PLANTAR SURFACE : Very premature  no detectable foot creases. Measure the foot length or heel-toe distance. Heel-toe distances: less than 40 mm  (-2) between 40 and 50 mm  (-1)

18. 4 . BREAST : The breast bud consists of: breast tissue that is stimulated to grow by maternal estrogens fatty tissue which is dependent upon fetal nutritional status.

19. 5 . EYE / EAR: Increasing maturity  Increasing cartilage content of ear. In very premature infants, the pinnae may remain folded when released. In such infants, state of eyelid development is an additional indicator of fetal maturation.

20. 6 . GENITALS: (MALE ) Fetal testicles begin their descent from the peritoneal cavity into the scrotal sack at approximately 30th week of gestation. The left testicle precedes the right and usually enters the scrotum during the 32nd week. Both testicles are usually palpable in the upper to lower inguinal canals by the end of the 33rd to 34th weeks of gestation. Concurrently , the scrotal skin thickens and develops deeper and more numerous rugae.

21. 6 . GENITALS: (MALE)

22. 6 . GENITALS: (FEMALE ) In extreme prematurity, the labia are flat and the clitoris is very prominent and may resemble the male phallus. As maturation progresses, the clitoris becomes less prominent and labia minora become more prominent. Near term, both clitoris and labia minora recede and are eventually enveloped by the enlarging labia majora.

23. 6 . GENITALS: (FEMALE) Hips should be only partially abducted, i.e., to approximately 45° from the horizontal with the infant lying supine. Exaggerated abduction may cause the clitoris and labia minora to appear more prominent, whereas adduction may cause the labia majora to cover over them.

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