Question

The Ballard scoring system for estimating gestational age in newborns can be started from which gestational age?

• A. 16 weeks
• B. 20 weeks
• C. 24 weeks
• D. 28 weeks

Hint:

Ballard Evolution:
$\bullet$ Original Ballard (1979): Valid from $22\text{--}24\text{ weeks}$ (minimum score: 5).
$\bullet$ New Ballard Score (1991): Valid down to 20 weeks (score of $-10 = 20\text{ weeks}$, $0 = 24\text{ weeks}$, $50 = 44\text{ weeks}$).

Answer 1

The Correct Option is B

Concept:
The Ballard scoring system (New Ballard Score) is an expanded and refined clinical tool used to assess the gestational age of neonates through systematic evaluation of neuromuscular and physical maturity.
The original Ballard score was modified by Dr. Jeanne L. Ballard in 1991 to accurately determine the gestational age of extremely premature infants.
Explanation:
• The original Dubowitz scoring system was valid down to 28 weeks, and the original 1979 Ballard score was accurate down to 22--24 weeks of gestation.

• The New Ballard Score (NBS) introduced negative scores ($-1$) for extremely immature physical and neuromuscular parameters, extending its validated accuracy down to 20 weeks of gestation (from $20$ to $44$ completed weeks).

• The assessment comprises 6 neuromuscular criteria (posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear) and 6 physical maturity criteria (skin, lanugo, plantar surface, breast, eye/ear, genitals).

• Total scores range from $-10$ (corresponding precisely to $20\text{ weeks}$) up to $50$ (corresponding to $44\text{ weeks}$), with every 5-point increase representing approximately a 2-week advance in gestational age.

• For maximum clinical accuracy in extremely preterm infants ($<26\text{ weeks}$), the examination should ideally be performed within the first $12$ hours of life.
Final Answer:
The New Ballard Scoring system accurately determines gestational age starting from 20 weeks of gestation.