Clinical Assessment of Gestational Age in the Newborn Infant by Ballard's Scoring System

Choi, Jung Hwan; Kim, Yong Ik; Yun, Choug Ku

Abstract

In recent years, there has been a rapidly increasing interest; in babies whose birthweight is low because their intrauterine growth has been retarded and it has been recognized that the clinical problems of these 'small-for-dates' infants differ from those of true prematures. Although it is very difficult to differentiate 'small-for-dates' infants from true prematures, it can be made readily if the gestational age is known. So there is a need for a rapid, accurate method of clinically assessing gestational maturation and it needs to be reliable and capable of being fully performed regardless of the degree of illness or well-being of infant. Using the Ballard's scoring system which was based on 6 physical criteria and 6 neurogical criteria, the author estimated the gestational age of 265 newborn infants who were born at the Obstetric ward of the Seoul National University Hospital from April to August in 1980. And the author compared the estimated gestional age with the gestational age calculated from LMP. The results were as followings: 1) The age distribution of the 265 newborn infants showed predominance in the weeks of gestational age and there was no discrepancy between two sexes. 2) The weight distribution of the 265 newborn infants showed predominance in the 2,500g-3, 500 g of birthweight. 3) The numbers of babies whose weight was appropriate, small and large for gestational age were 233(88%), 19(7%), and 13(5%) respectively according to University of Colorado Medical Center Example. 4) The examination was performed between 6 hours and 72 hours after birth, and the average time required to complete the full examination ranged from 3 minutes and 25 second to 6 minutes and 50 seconds, averaging 5 minutes and 30 seconds. 5) The predictive values of 6 physical criteria, when compared with the gestational age calculated from LMP were as following: skin(0,855), breast(0.842), plantar creases(0.830), ears (0.823), lanugo (0.773) and genitals (M: 0.760, F: 0.703) . 6) The predictive values of 6 neurological criteria when compared with the gestational age calculated from LMP were as following: popliteal angle(0.752), heel to ear(0.727), scarf sign (0.715), square window(0.693), posture(0682) and arm recoil(0.633). 7) The correlation of the score from the total criteria was greater than that obtined from any of its individual criteria. 8) The correlation coefficiency between the estimated gestational age and that calculated from LMP was 0.745 and the regression formula for the latter(X) against the former(Y) was Y=0.83X+ 6.79. With the above results, the author could conclude that the clinical estimation of the gestational age with the Ballard's scoring system was highly correlated and it deserves to be recommended for clinical purpose if the problems of the maturity rating would be solved.