Scribd Logo
Upload

Welcome to Scribd!

  • 6 views

    Neonatal-Assessment Ballard Scoring1

    Uploaded by

    Mikee Fernandez Tangub

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Neonatal-Assessment Ballard Scoring1

    Uploaded by

    Mikee Fernandez Tangub
    6 views32 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    6 views32 pages

    Neonatal-Assessment Ballard Scoring1

    Uploaded by

    Mikee Fernandez Tangub

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 32

    The New Ballard

    Scoring System
    Cygnette S. Lumbo, R.N., Ph. D.
    Neonatal Gestational Age Assessment
    ⚫ The physical maturity part of the examination should
    be done in the first two hours of birth
    ⚫ The neuromuscular maturity examination should be
    completed with 24 hours after delivery
    ⚫ Derived to look at various stages in an infants
    gestational maturity and observe how physical
    characteristics change with gestational age
    ⚫ Neonates who are more physically mature normally
    have higher scores than premature infants
    ⚫ Points are awarded in each area -2 for extreme
    prematurity to 5 for postmature infants
    Neuromuscular Maturity Criteria
    ⚫ Posture & Tone
    ⚫ Square Window
    ⚫ Arm Recoil
    ⚫ Popliteal Angle
    ⚫ Scarf Sign
    ⚫ Heel to Ear
    Posture and Tone
    ⚫ Total body muscle tone is reflected in the infant's preferred
    posture at rest and resistance to stretch of individual
    muscle groups.
    ⚫ Observe in the supine position at rest
    ⚫ Score is assigned based on the degree of flexion of arms,
    knees and hips
    ⚫ Increased flexion and hip adduction with increased
    gestational age
    ● The more mature an infant is the greater their tone
    will be
    ● A more flexed position indicated greater tone
    ● Posture & Tone
    ● Before 30 weeks-
    hypotonic, little or no
    flexion seen
    ● 30-38 weeks-varying
    degrees of flexed
    extremities
    ● 38-42 weeks-may appear
    hypertonic
    Square Window
    ⚫ Wrist flexibility and/or resistance to extensor stretching
    resulting in angle or flexion at wrist

    ⚫ Infant’s hand is flexed on the forearm between the thumb


    and index finger of the examiner

    ⚫ Apply enough pressure to get full flexion without rotating


    the wrist
    ⚫ Angle between the forearm and the palm is measured.
    ⚫ Before 26 weeks-wrist can’t be flexed more than 90
    degrees
    ⚫ Before 30 weeks-wrist can be flexed no more than 90
    degrees
    ⚫ 36-38 weeks-wrist can be flexed no more than 90
    degrees
    Arm Recoil
    ⚫ Measures the angle of recoil following a brief
    extension of the upper extremity
    ⚫ For 5 seconds flex the arms while infant is in the
    supine position, pulling the hands fully extend the
    arms to the side, then release-measure the degree of
    arm flexion & strength (recoil)
    ⚫ Before 28 weeks-no recoil
    ⚫ 28-32 weeks-slight recoil
    ⚫ 32-36 weeks-recoil does not pass 90 degrees
    ⚫ 36-40 weeks-recoils to 90 degrees
    ⚫ After 40 weeks-rapid full recoil
    Popliteal Angle
    Assesses maturation of
    Look at the angle between the
    passive flexor tone about lower leg, thigh and posterior
    the knee joint by testing knee.
    resistance to extension of
    the leg
    The angle decreases with
    Place infant in supine advancing gestational age
    position with the pelvis on
    ⚫ Before 26 weeks-angle 180
    the mattress degrees
    Using the thumb and index ⚫ 26-28 weeks-angle 160
    finger of one hand, degrees
    examiner holds the knee ⚫ 28-32 weeks-angle 140
    adjacent to the chest and degrees
    abdomen ⚫ 32-36 weeks angle 120
    Gently extend the leg with the degrees
    index finger
    Scarf Sign
    ⚫ Tests the passive tone of the ⚫ Before 28 weeks-elbow
    flexors about the shoulder passes torso
    girdle ⚫ 28-34 weeks-elbow
    ⚫ Increased resistance to this passes opposite nipple
    maneuver with advancing line
    gestational age ⚫ 34-36 weeks-elbow can
    ⚫ Place infant in supine position be pulled past midline,
    with head in mid-line no resistance
    position. ⚫ 36-40 weeks-elbow to
    ⚫ Grasp the infants hand and midline with some
    pull the arm across the chest resistance
    and around the neck. ⚫ After 40 weeks-doesn’t
    ⚫ Look at the relationship of reach midline
    elbow to mid-line of body
    when arm pulls across the
    chest
    Heel to Ear
    Measures passive flexor tone
    about the pelvic girdle by
    testing passive flexion or ⚫ Breech infants will score
    resistance to extension of the lower than normal
    posterior hip flexor muscles
    ⚫ Before 34 weeks-no
    resistance
    Place the infant supine with ⚫ 40 weeks-great resistance
    pelvis flat on table. may be difficult to perform
    Grasp one foot with thumb and
    index finger and draw foot as
    near to head as possible.
    Note the distance between the
    foot and head as well as degree
    of knee extension
    Physical Maturity Criteria
    ⚫ Skin
    ⚫ Lanugo
    ⚫ Plantar Surface
    ⚫ Breast
    ⚫ Eye/Ear
    ⚫ Genitalia- Male
    ⚫ Genitalia- Female
    Skin
    ⚫ Maturation of fetal skin
    involves the development
    of its intrinsic structures
    concurrent with the
    gradual loss of its
    protective coating, the
    vernix caseosa. Hence, it
    thickens, dries and
    becomes wrinkled and/or
    peels, and may develop a
    rash as fetal maturation
    progresses.
    Lanugo
    ⚫ Lanugo is the fine hair
    covering the body of the
    fetus.
    ⚫ In extreme immaturity, the
    skin lacks any lanugo. It
    begins to appear at
    approximately the 24th to
    25th week and is usually
    abundant, especially across
    the shoulders and upper
    back, by the 28th week of
    gestation.
    Plantar Surface
    ⚫ The plantar surface is
    assessed for major foot
    creases on the sole of the
    foot. The first
    appearance of a crease
    appears on the anterior
    sole at the ball of the
    foot. this may be related
    to foot flexion in utero,
    but is contributed to by
    dehydration of the skin.
    Breast
    ⚫ The breast bud consists of breast
    tissue that is stimulated to grow
    by maternal estrogens and fatty
    tissue which is dependent upon
    fetal nutritional status. the
    examiner notes the size of the
    areola and the presence or
    absence of stippling (created by
    the developing papillae of
    Montgomery).
    ⚫ The examiner palpates the
    breast tissue beneath the skin by
    holding it between thumb and
    forefinger, estimating its
    diameter in millimeters.
    Ear
    ⚫ The pinna of the fetal ear ⚫ The examiner notes the
    changes it configuration rapidity with which the
    and increases in cartilage folded pinna snaps back
    content as maturation away from the face when
    progresses. Assessment released.
    includes palpation for
    cartilage thickness, then
    folding the pinna
    forward toward the face
    and releasing it.
    Eye ⚫ The examiner places
    thumb and forefinger on
    the upper and lower lids,
    gently moving them
    apart to separate them.
    ⚫ The extremely immature
    infant will have tightly
    fused eyelids, i.e., the
    examiner will not be able
    to separate either
    palpebral fissure with
    gentle traction.
    Genitalia-Male
    ⚫ The fetal testicles begin their ⚫ The scrotal skin thickens and
    descent from the peritoneal develops deeper and more
    cavity into the scrotal sack at numerous rugae.
    approximately the 30th week
    of gestation.
    ⚫ The left testicle precedes the
    right and usually enters the
    scrotum during the 32nd
    ⚫ testicles are usually palpable
    in the upper to lower inguinal
    canals by the end of the 33rd
    to 34th weeks of gestation.
    Genitalia- Female
    ⚫ To examine the infant female, ⚫ Nearing term, both clitoris and
    the hips should be only labia minora recede and are
    partially abducted, i.e., to eventually enveloped by the
    approximately 45° from the enlarging labia majora.
    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.
    ⚫ The New Ballard Score allows scores of -1 for the criteria,
    hence making negative scores possible. The possible scores
    then range from -10 to 50, the gestational range extending
    up to 20 weeks. (A simple formula to come directly to the
    age from the Ballard Score is Age=((2*score)+120)) / 5

    ⚫ For simple calculation, the scores of both neuromuscular


    and physical maturity are added and are corresponded to
    the maturity rating
    ⚫ Mturity rating:
    Score/weeks:
    (-10/20),(5/22),(0/24),(5/26),(10/28),
    (15/30),(20/32),(25/34),(30/36),(35/38),
    (40/40),(45/42),(50/44).
    References
    The Ballard Score Maturational Assessment of
    Gestational Age in Newly Born Infants. Retrieved from
    https://www.ballardscore.com/
    Aby, J. (2008). Stanford School of Medicine. Newborn
    Nursery at LPCH. Retrieved October 10th, 2009 from
    http://newborns.stanford.edu/RNMDEducation.html
    Ballard J. (1991). New Ballard Score, expanded to include
    extremely premature infants. Journal of Pediatrics, 119,
    417-423.
    NCM 107
    Skills Lecture Series

    The New Ballard Scoring System

    DrCSLumbo

    You might also like