Wednesday, 29 August 2012

Gestational Assesment of Newborns


Introduction:
Gestational age is very much vital in predicting newborns’ outcome & problems in neonatal phase. Assessment of gestational age in premature babies by calculation based upon the date of expected delivery & last menstrual period often goes wrong and varies from actual appearance of baby. Hence clinical assessment of gestational age in newborns especially of prematures is  mandatory.

With progress of gestational age, babies develop a wide range of characteristics that can be measured through simple examination. As the baby develops muscle tone, distinct posture ensues, as well as measurable angles of resistance in key muscle groups.
 Similarly physical characteristics are also key in determining gestational age. The eyes transform from being fused in very premature infants, to wide open in full-term babies. The skin and hair also give away important information in determining gestational age, as well as a host of other characteristics described in this site.

Thus taking in to account both physical and neuromuscular changes the newborn’s gestational age assessment by various processes was designed by Dr. Jeanne L Ballard, MD. It is known as ‘ Ballard Score ‘.

It assigns a score to various criteria, the sum of all of which is then extrapolated to the gestational age of the baby. These criteria are divided into Physical and Neurological criteria. This scoring allows for the estimation of age in the range of 26 weeks-44 weeks. The New Ballard Score is an extension of the above to include extremely pre-term babies i.e. up to 20 weeks. 



Below mentioned chart shows the the criteria & scoring patterns.  Use this score sheet to assess the gestational maturity of your baby. At the end of the examination the total score determines the gestational maturity in weeks.

PHYSICAL MATURITY

NEUROMUSCULAR MATURITY

Each of the above criteria are scored from 0 through 5, in the original Ballard Score. The scores were then ranged from 5 to 50, with the corresponding gestational ages being 26 weeks and 44 weeks. An increase in the score by 5, increases the age by 2 weeks. The New Ballard Score allows scores of -1 for the criteria, hence making negative scores possible.


MATURITY RATING
TOTAL SCORE
(NEUROMUSCULAR + PHYSICAL)
WEEKS
-1020
-522
024
526
1028
1530
2032
2534
3036
3538
4040
4542
5044



References:
·         Ballard JL, Khoury JC, Wedig K, et al: New Ballard Score, expanded to include extremely premature infants. J Pediatrics 1991; 119:417-423.

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