New Ballard Score | PaedCare KGH

📋 Patient Registration

Baby ID / File No.

Mother's Name

Admission Number

Ward / Unit

Sex

Birth Weight (grams)

Enter weight in grams (300–6000 g). Example: 1500 g, not 1.5.

⚠️ Value looks like kilograms. Enter in grams (e.g. 1500, not 1.5). Normal newborn range: 300–6000 g.

GA by LMP / USG (wks)

Used for comparison only, not Ballard calculation.

Assessment Date & Time

Clinician / Assessed By

Neuromuscular progress0 / 6

🧠 NEUROMUSCULAR MATURITY (−1 to +4 per item; Popliteal to +5)

1. Posture

Observe at rest (supine)

—

−1

Arms & legs extended

0

Slight or no flexion

1

Slight hip flexion

2

Moderate hip/knee flexion

3

Hip flexed, knees flexed

4

Full flexion all limbs

2. Square Window (Wrist)

Flex hand on forearm; measure angle

—

−1

>90°

0

90°

1

60°

2

45°

3

30°

4

0°

3. Arm Recoil

Extend arms 5 s; release; note recoil angle

—

−1

180° (no recoil)

0

180°

1

140–180°

2

110–140°

3

90–110°

4

<90°

4. Popliteal Angle

Flex thigh on abdomen; extend leg

—

−1

180°

0

160°

1

140°

2

120°

3

100°

4

90°

5

<90°

5. Scarf Sign

Pull arm across chest; note elbow position

—

−1

Elbow past axilla

0

Elbow to axilla

1

Elbow to mid chest

2

Elbow at midline

3

Elbow short of midline

4

Elbow at/near sternum

6. Heel to Ear

Draw foot to ear; note resistance

—

−1

No resistance

0

Foot at ear easily

1

Near ear

2

Above knee level

3

At knee level

4

Below knee

Physical progress0 / 6

🧬 PHYSICAL MATURITY (−2 to +5 per item)

7. Skin

Observe texture, transparency, peeling

—

−1

Sticky, friable, transparent

0

Gelatinous, red, translucent

1

Smooth, pink, visible veins

2

Superficial peeling / rash

3

Cracking, pale, few veins

4

Parchment, deep cracking

5

Leathery, cracked, wrinkled

8. Lanugo

Fine hair on back

—

−1

None

0

Sparse

1

Abundant

2

Thinning

3

Bald areas

4

Mostly bald

9. Plantar Surface

Sole creases / heel-toe length

—

−2

Heel–toe <40 mm, no crease

−1

40–50 mm; no crease

0

Faint red marks

1

Anterior transverse crease only

2

Creases anterior 2/3

3

Creases over entire sole

10. Breast

Palpate areola and bud

—

−1

Imperceptible

0

Barely perceptible

1

Flat areola, no bud

2

Stippled areola, 1–2 mm bud

3

Raised areola, 3–4 mm bud

4

Full areola, 5–10 mm bud

11. Eye / Ear

Lid fusion / pinna cartilage & recoil

—

−2

Lids fused tightly

−1

Lids fused loosely

0

Lids open; pinna flat, stays folded

1

Slightly curved pinna; slow recoil

2

Well-curved pinna; ready recoil

3

Formed & firm; instant recoil

4

Thick cartilage; ear stiff

12. Genitals

Select baby's sex on Patient tab to enable this criterion

—

GA Comparison

Ballard GA: —

Documented GA (LMP/USG): —

Difference: —

—

⚠️ Clinical Correlation Alert

Ballard GA: —

Documented GA (LMP/USG): —

Difference: —

Review:

Reliability of LMP dates
Timing and quality of antenatal ultrasound
Timing of Ballard assessment (optimal: 12–20 hrs after birth)
Severe illness, hypoxia, or oedema affecting tone and maturity signs
Maternal medications or sedation
Neuromuscular depression or congenital neuromuscular conditions
Intrauterine growth restriction or other clinical factors

This alert is informational only. Final gestational age should be determined by overall clinical assessment.

📋 Ballard 1991 — Score → Gestational Age

Total Score	GA (weeks)	Category
−10 to −5	20	Extremely Preterm
−4 to 0	22	Extremely Preterm
1 to 5	24	Extremely Preterm
6 to 10	26	Very Preterm
11 to 15	28	Very Preterm
16 to 20	30	Preterm
21 to 25	32	Preterm
26 to 30	34	Late Preterm
31 to 35	36	Late Preterm
36 to 40	38	Term
41 to 45	40	Term
46 to 50	42	Post-term

✅ Clinical guidance: Best assessed within 12–20 hours of birth. In infants <26 weeks, neuromuscular criteria may be more reliable than physical maturity signs. Illness, oedema, shock, hypoxia, sepsis, sedation, maternal analgesia, and neuromuscular conditions may affect scoring. This tool supports — but does not replace — neonatal examination, LMP/USG dating, and senior clinical judgement.

Final gestational age should be assigned after correlation with LMP, ultrasound dating, neonatal examination, clinical condition and senior neonatologist judgement.

📚 References & Limitations ▼

References

Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr. 1991;119(3):417–423.
Cloherty JP, Eichenwald EC, Hansen AR, Stark AR. Manual of Neonatal Care. Latest available edition.
World Health Organization. Born Too Soon: The Global Action Report on Preterm Birth. Geneva: WHO; 2012.

Limitations

Based on the New Ballard Score. Intended as a clinical support tool and not a substitute for trained neonatal assessment, LMP dating, ultrasound dating, or senior clinical judgment.
Accuracy depends on correct observation technique and examiner experience.
Scores may be affected by illness, oedema, shock, hypoxia, sepsis, sedation, maternal analgesia, neuromuscular disorders, and extreme prematurity.
Birth weight entered here is for documentation only; not part of Ballard GA calculation.
Incomplete scoring should not be used to generate a definitive GA estimate.
Final GA must be made by a trained clinician or neonatologist.
App data stored locally on user's device only.

📐 GA Documentation Analytics

Ballard Total

—

Ballard GA

—

LMP/USG GA

—

GA Difference

—

Agreement

—

Prematurity Category

—

Completeness

—

Neuromuscular Sub

—

Final GA Documentation Suggestion

Complete scoring to generate suggestion

Final gestational age must be confirmed by the clinician after correlating with LMP, ultrasound, and clinical assessment.

📏 Birth Weight–GA Plausibility Review

Birth Weight—

Ballard GA—

—

Birth weight alone cannot determine gestational age and must not replace Ballard assessment, antenatal dating, ultrasound findings, or clinical judgement. This is an observational research analytic only.

🕐 Assessment Timing & Birth Details

Date of Birth

⚠️ Future date/time is not allowed in research mode.

Time of Birth

Age at Assessment (hrs) — Auto-calculated

Singleton / Multiple

Place of Birth

Mode of Delivery

Vaginal

LSCS

Instrumental

Unknown

Antenatal Steroid

Complete

Partial

Not given

Unknown

📅 Maternal Dating Reliability

Reliable LMP

Uncertain LMP

1st trimester USG

Later USG

No USG available

⚕️ Clinical Factors Affecting Ballard Score

Select all that apply — may affect score reliability

Severe illness

Shock

Sepsis

Hypoxia/asphyxia

Oedema

Sedation/maternal drugs

Neuromuscular abnormality

IUGR/SGA suspicion

None documented

📋 Outcome Documentation

NICU Admission

Yes

No

Growth Category (clinician-entered, chart-based outside this app)

SGA (<10th centile)

AGA (10th–90th)

LGA (>90th centile)

Not assessed

Enter clinician's growth classification based on Fenton, INTERGROWTH-21, or WHO centile charts. This app does not auto-calculate SGA/AGA/LGA. Specify the GA used for classification (Ballard GA / LMP/USG GA) in Remarks if relevant.

Respiratory Support Used

Room air

Oxygen

CPAP

NIV

Mechanical ventilation

Surfactant

Final Hospital Outcome

Discharged

LAMA

Referred

Death

Still admitted

Transferred within hospital

Outcome Date

⚠️ Future date/time is not allowed in research mode.

Length of Stay (days)

Final Diagnosis / Major Morbidity

RDS

Sepsis

Birth asphyxia/HIE

Hypoglycemia

Jaundice

NEC

Feeding difficulty

Congenital anomaly

Other

Remarks / Notes

⚠️ Research note: Research fields are for local audit and documentation only. They do not affect the Ballard calculation. Final gestational age should be assigned after correlation with LMP, ultrasound dating, neonatal examination, clinical condition and senior neonatologist judgement. Ballard GA is usually accurate to within ±2 weeks. Incomplete scoring must not generate a definitive GA estimate.

🔒 Privacy & De-identification (IEC Compliance)

📈 Research Dashboard

Local audit analytics — AMC/KGH NICU · Data stored on this device only

📊

No research records saved yet.
Complete an assessment, fill research fields, and tap Save Research Record.