Ballard Score: Gestational Age Estimation

The New Ballard Score is a clinical tool used to assess and estimate the gestational age of a newborn based on neuromuscular maturity and physical characteristics. It is essential for providing appropriate care to premature, term, or post-term infants.

Neuromuscular Maturity

Posture

-1: Extended arms and legs

0: Slightly flexed arms and legs

1: Flexed arms and legs

2: Flexed arms and legs, with flexion of the hips

3: Marked flexion of the arms and legs

4: Full flexion of arms and legs, with a tight grip

Square Window

-1: > 90°

0: 90°

1: 75°

2: 60°

3: 45°

4: 30°

5: 0°

Arm Recoil

-1: No recoil

0: Slight recoil

1: Slight flexion

2: Recoil to a flexed position

3: Brisk recoil to full flexion

4: Recoil to a flexed position with a tight grip

Popliteal Angle

-1: > 180°

0: 180°

1: 160°

2: 140°

3: 120°

4: 100°

5: < 90°

Scarf Sign

-1: Elbow passes the midline

0: Elbow reaches the midline

1: Elbow does not reach the midline

2: Elbow does not cross the axillary line

3: Elbow does not cross the midline, with some resistance

Heel to Ear

-1: Leg fully extended, heel easily reaches the ear

0: Leg extended, heel reaches the lower part of the ear

1: Heel is near the ear, but there is some resistance

2: Heel reaches the level of the navel, with some resistance

3: Heel reaches the hip level, with resistance

4: Heel does not reach the hip level, with much resistance

Physical Maturity

Skin

-1: Translucent, red, sticky

0: Smooth, pink, visible veins

1: Flaky, pale

2: Cracked, few visible veins

3: Cracked, peeling, no veins

4: Leathery, cracked, wrinkled

5: Wrinkled, thick, no veins

Lanugo

-1: Absent

0: Scant

1: Abundant

2: Some thinning

3: Bald areas, mostly absent

4: Mostly absent

Plantar Creases

-1: No creases, < 40mm

0: Faint red marks, no creases

1: Anterior transverse crease only

2: Creases on the anterior half

3: Creases on the anterior two-thirds

4: Creases on the entire sole

Breast

-1: Imperceptible

0: Barely perceptible

1: 1-2 mm nodule

2: 5-10 mm nodule

3: 10-15 mm nodule

4: 15-20 mm nodule

5: > 20 mm nodule

Eye/Ear

-1: Eyelids fused, cannot be opened

0: Eyelids fused, can be partially opened

1: Lids open, pinna flat, stays folded

2: Pinna curved, soft, slow recoil

3: Well-formed pinna, firm, fast recoil

4: Thick cartilage, ear stiff

Genitals

-1:
Male: Scrotum is flat and smooth.
Female: Clitoris prominent, labia minora open.

0:
Male: Scrotum is smooth, pink, rugae absent.
Female: Clitoris prominent, labia minora open.

1:
Male: Scrotum has few rugae.
Female: Labia minora slightly prominent.

2:
Male: Testes descend, few rugae.
Female: Labia minora more prominent.

3:
Male: Testes down, good rugae.
Female: Labia minora and majora equal.

4:
Male: Testes pendulous, deep rugae.
Female: Labia majora cover the minora.

5:
Male: Testes pendulous, scrotum full.
Female: Labia majora completely cover the minora and clitoris.

Bibliographic Reference

Ballard, J. L., Khoury, K., Wedig, K., et al. (1991). New Ballard Score for Gestational Age. Journal of Pediatrics, 119(4), 541-546.