New Ballard Score for Gestational Age Assessment (Nursing)

by Jacquelyn McMillian-Bohler

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    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.

    About the Lecture

    The lecture New Ballard Score for Gestational Age Assessment (Nursing) by Jacquelyn McMillian-Bohler is from the course Newborn Assessment (Nursing).

    Included Quiz Questions

    1. Gestational age
    2. Neuromuscular maturity
    3. Physical maturity
    4. Transition post-birth
    5. Lung status
    1. Resistance
    2. Flexibility
    3. Stiffness
    4. Rigidity
    1. - 1 to 5
    2. 2–8
    3. 2–5
    4. - 5 to 5
    1. More creases
    2. Smooth surface
    3. Bumps
    4. White spots

    Author of lecture New Ballard Score for Gestational Age Assessment (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler

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