New Ballard Score calculator
The New Ballard Score estimates the newborn’s gestational age from neuromuscular and physical maturity. It is the method of choice for extremely preterm infants because the scale starts at 20 weeks. Choose the sex, score the 12 items and the result appears in weeks and days.
Choose the sex and score the 6 neuromuscular maturity items and the 6 physical maturity items. The sum (−10 to 50) is converted to gestational age with the New Ballard table.
Neuromuscular maturity
Physical maturity
Every 5 points correspond to 2 weeks; the table runs from 20 weeks (−10 points) to 44 weeks (50 points). Accuracy of about 2 weeks. The neuromuscular examination requires a stable newborn; in a depressed, sedated or under-12-hour-old infant the neurologic items underestimate GA.
Clinical decision-support tool for use by healthcare professionals. It does not replace clinical judgment or your unit's protocols.
How the calculation works
Six neuromuscular items (posture, square window, arm recoil, popliteal angle, scarf sign and heel to ear) and six physical items (skin, lanugo, plantar surface, breast, eye and ear, genitals) receive −2 to 5 points. The sum ranges from −10 to 50 and is converted to gestational age with the table published by Ballard in 1991: every 5 points equal 2 weeks, from 20 to 44 weeks.
When to apply
Ideally examine between 12 and 96 hours of life, with the newborn awake and stable. In extremely preterm infants an early examination, before 12 hours, is acceptable. Neuromuscular items lose value in a depressed, sedated or asphyxiated newborn; in those cases weigh physical maturity more heavily. Accuracy is about 2 weeks.
Example
Male newborn: posture with moderate flexion (2), square window 45° (2), arm recoil 110° to 140° (2), popliteal angle 120° (2), scarf sign at the midline (2), heel to ear at chest level (2); smooth pink skin with visible veins (1), abundant lanugo (1), anterior transverse crease only (2), stippled areola with a 1 to 2 mm bud (2), slightly curved pinna (2), testes descending with few rugae (2). Sum: 22 points, corresponding to 32 weeks and 6 days.
Frequently asked questions
What is the difference between Capurro and New Ballard?
Capurro uses 5 or 6 signs and is only valid from 29 weeks. New Ballard uses 12 items and covers 20 to 44 weeks, so it is the indicated method for extremely preterm infants. Both have an error of 1 to 2 weeks.
Does New Ballard replace obstetric ultrasound?
No. Dating by a reliable LMP or first-trimester ultrasound remains the reference. New Ballard is the resource when that information is missing or disagrees with the physical examination.
Why can the score be negative?
The −1 and −2 items were added in the 1991 revision precisely to describe extremely preterm infants, with sticky skin, fused eyelids and no lanugo. A sum of −10 corresponds to 20 weeks.
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):417-23.
- Brazilian Society of Pediatrics (SBP). Department of Neonatology. Assessment of gestational age in the newborn. Scientific document.
- Brazilian Ministry of Health. Newborn health care: a guide for health professionals. Volume 1. Brasília; 2014.
