00:01
Now, we've completed the
head to toe general assessment.
00:05
Now, we can look into gauging
information about the maturity
or gestational age of the baby,
and also neurologic maturity.
00:14
Because we can put those things
together to really accurately guess.
00:18
We have a guess based on
our ultrasound or due date
but if we really want to know
how accurate that assessment was,
we can use the
new Ballard assessment
in order to give us more information
to validate our gestational age.
00:31
Let's talk about
what that looks like.
00:33
So the New Ballard Assessment can
be done up to four days after birth.
00:38
And the reason why four days
is used is because after that
the baby's been around people
and they're adapting
to their environment.
00:45
And so the information we collect
is not going to
necessarily be accurate.
00:49
It's also accurate plus
or minus two weeks.
00:52
So just like our
last menstrual period,
or our second trimester ultrasound,
this can be a way
to predict accurately
what was the gestational age
of the baby.
01:02
When would we use this assessment?
Typically, when we have no idea what
the gestational age of the baby is.
01:08
So if we have a client
that comes in
that maybe showed up late
for prenatal care,
didn't have prenatal care,
or someone who maybe
didn't have good dating
at the first part
of their pregnancy,
then we can use this
as a way to again
further validate what the
gestational age of that baby is.
01:26
Let's take a look at the two parts
of the New Ballard Assessment
because they're actually two.
01:31
The first part is the measurement
of neuromuscular maturity.
01:35
So what you'll notice on
the horizontal axis is a score
that goes -1, 0, 1,
all the way up to five.
01:42
And then down the vertical axis
you'll see the actual assessment.
01:47
So for neuromuscular maturity,
posture is measured.
01:50
So look at the graphic of the baby.
01:52
Remember, we talked in our
general survey about tone,
you'll see that a preemie baby
is more likely to be flaccid.
01:59
But as we get closer to four,
we get closer to a more mature baby
and you start to see
the flexion of the muscles.
02:06
So notice the range from
premature to term for posture.
02:11
For square window,
we're talking about the arm
and you'll notice that
as the connective tissue
develops in the arm,
we have greater flexibility.
02:19
So a preemie baby
won't have much flexibility
because of the decreased in the
development of connective tissue,
but it will be greater as
the baby becomes more mature.
02:28
Arm recoil, you'll notice the
greater in terms of gestational age,
the more arm recoil
the baby will experience.
02:36
Popliteal angle refers to the way
that the leg is able to extend
away from the bottom.
02:43
So preemie babies,
well, they're flexible.
02:45
And so you can bring the
baby's heel and their toes
all the way up to the top of
their head without any problem.
02:51
But if you try to do that
with a term baby,
they'll give you some resistance.
02:55
So you'll see the difference
there with popliteal angle.
02:57
So remember popliteal angle refers
to that space right behind the knee.
03:02
For the scarf sign,
what we're actually doing
is measuring where the elbow moves
across the midline of the body.
03:10
So for a preemie baby
flexible, flexible, flexible,
we can take that arm and almost
wrap it around the head.
03:16
But for a term baby, they're
going to say, "not so fast."
And they're going to give you
some resistance,
so you won't be able
to pull that arm
all the way across.
03:23
Notice the difference.
03:25
And then finally, the heel to ear.
03:27
So with the popliteal angle,
the toe comes across
the front of the body.
03:31
But for heel to ear,
we're doing sort of a side stretch.
03:34
So we're pulling
the entire leg out on the outside.
03:38
So it's sort of lateral
and not up and down.
03:41
So are we able to get the heel
all the way to the ear?
Or are we meeting some resistance?
Now, it's important to recognize
that if the baby's
received medication
or the birthing person received
medication during labor,
then that absolutely can affect
a neurologic assessment.
04:00
So just like it might make the
birthing person sleepy
or a little lethargic,
it'll do the same thing
to the baby.
04:06
And so until that medication
clears the system,
this will not be an
accurate measurement.
04:12
Fortunately, there are two parts
to the New Ballard Assessment.
04:16
And the physical maturity
is not affected by medication.
04:19
So let's take a look at
the assessments there.
04:22
So again, on the vertical axis,
we're going to look at a score
minus one all the way to five.
04:27
I'm going to tell you what to do
with that in just a second.
04:29
So just keep that in mind.
04:31
And then on the vertical axis,
you'll notice the assessments.
04:34
So we'll assess the skin.
04:36
And for preemie babies,
you'll notice that the skin
is friable and transparent
thinking about what that skin
would look like
versus a postdates baby
that might have
leathery or cracked
or wrinkled skin
because all of the what is gone.
04:50
Vernix caseosa exactly.
So think about the extremes.
04:55
With the lanugo the baby fine hair.
04:57
So thinking about a super
preemie baby might not have any.
05:01
And then as we get to
production of more lanugo,
you'll see the amount goes up.
05:07
And then by the time
we get to a postdates baby,
then we're mostly bald again.
So you see the range.
05:13
So for plantar surfaces,
we're looking
at the soles of the feet.
05:17
And we're looking to see
if we see creases or lines
and that lets us know that
the baby is more mature.
05:25
So a preemie baby's
going to have really
smooth surfaces
on their plantar areas,
and a post term or a term baby
is going to have more creases.
05:35
So a baby that has creases on
more than two thirds of their feet
is going to be a baby
that's associated
with a term baby versus preterm.
05:44
Next, think about the breast.
05:46
We talked about
the influence of estrogen.
05:49
So if a baby's preterm,
they're likely to have
imperceptible breast buds.
05:54
But when we get to a
post date or a term baby,
we will begin to feel the areola
and notice the development
of the breast buds.
06:03
For the eyes and ears.
06:05
A baby that has fused eyes
or ears that fold over really easily
so not a lot of
connective tissue there.
06:11
Then we will notice that is
the case for a preterm baby.
06:15
But for a baby that
is term or post dates,
the cartilage will be thick,
the ear will be stiff,
the eyes will be open.
06:22
For genitals.
We've talked about this briefly,
but just to review,
for male genitalia, the scrotum
will be flat and smooth.
06:30
For a term baby, the scrotum will
have deep brew gay, so deep ridges.
06:34
For the female,
the clitoris and the labia minora
are going to be prominent.
06:40
For a term baby,
the labia majora is going to cover
the clitoris and the labia minora.
06:46
And you won't see them
unless you open the labia folds.
06:50
Now, I promised I would tell you
how to put this all together.
06:53
And this is what it looks like.
06:55
So we take the
neuromuscular maturity
and we add up the score for
each one of those assessments.
07:02
And we add the
physical maturity and same scale.
07:05
We give the baby a score for
each one of those assessments.
07:08
And we add those numbers together.
07:10
And that gives us
our gestational age
plus or minus two weeks.
07:15
So this is the
New Ballard Assessment.