The Ballard Test: Assessing Gestational Age & Infant Maturity

The Ballard test is a scale used to estimate the gestational age of a newborn infant. The test evaluates the neuromuscular and physical maturity of an infant. There are six different areas of neuromuscular maturity that are rated. Seven different areas of physical maturity are rated based on observation of the infant. Gestational age is the measure of time an infant spends growing in the womb before birth.

It’s an important factor to determine because it can be an indicator of any potential problems that the newborn might develop. Gestational age can also reveal whether or not it was a healthy pregnancy.

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Assessing Neurological Features In order to assess the newborn’s neurological features the infant should be awake, not crying and lying on her back. You then score the infants posture based on your observation of free movement of the limbs. The following features are scored based on your observation when you manipulate the limbs: square window, arm recoil, popliteal angle, scarf sign and heel to ear. Assessing External Features The external features are scored based on your observation of the infant. These external features include: skin, lanugo, plantar creases, breast, ear, genitalia.

Scoring External and neurological features are rated based on a score of zero to four. When scoring you should observe both sides of the infant and half scores can be used. All the scores are then added up for a final score. The final score is then compared to a table which gives the approximate gestational age. If the final score is within two weeks of the mother’s dates, then her dates are acceptable. If the dates are over or under two weeks of the score then the mother’s dates should be deemed incorrect and you should accept the gestational age based on the Ballard score.

Besides the Ballard test, you can look for observable clinical signs to help determine whether the infant is full-term or pre-term. You should observe such things as sucking ability, flexing of arms and legs, whether or not you can see the veins under the skin, development of the nipple and breast bud, descended testes and covered labia minora. The weight and head circumference of the infant should also be taken into consideration. Learning Objectives • The first learning objective is to describe the Ballard scales used in assessing the newborn.

• The second learning objective is to define the purposes of the scales. • The third learning objective is to explain the importance of the newborn’s Ballard scores. • The fourth learning objective is to describe normal and abnormal gestational age relative to the weight of the newborn. Definitions • The first definition of the Ballard test is to determine normal and abnormal features of a newborn. • The second definition of the Ballard test is to determine normal neurological responses of a newborn.

• The third definition of the Ballard test is to discern normal physiological features of a newborn. • The fourth definition of the Ballard test is to determine the gestational age of the newborn and the correlation between the gestational age and the weight of the newborn. Teaching Methodology • A prior knowledge of embryology and fetal physiology is helpful. A basic knowledge of antepartum and intrapartum care is necessary. As well as familiarity with maternal screening tests and common maternal complications that may arise.

• Develop questions to be asked in order to gather information and history related to pregnancy, labor and delivery. • List the key elements of the physical assessment of a newborn. • Discuss how all of these elements in conjunction with the Ballard test can determine the gestational age of the newborn. • Identify the important indicators of gestational maturity and immaturity. • Discuss the effects that gestational age has on a newborn. • Discuss the transition of the newborn from the womb into the environment.

A Nursing diagnosis or NANDA • Actual diagnosis - Ineffective airway clearance related to decreased energy as manifested by an ineffective cough. • Risk diagnosis - Risk for injury related to altered mobility and disorientation. • Possible diagnosis - Possible fluid volume deficit related to frequent vomiting for three days as manifested by increased pulse rate. • Syndrome diagnosis - Rape-trauma syndrome related to anxiety about potential health problems as manifested by anger, genitourinary discomfort, and sleep pattern disturbance.

• Wellness diagnosis - Potential for enhanced organized infant behavior, related to prematurity and as manifested by response to visual and auditory stimuli. ( (Nanda Nursing Diagnosis) Works Cited "Assessing The Gestational Age. " 2005. Newborn Care. 14 October 2008 <http://www. gfmer. ch/PEP/pdf/SW-17-2005. pdf>. Hull, J. W. "Ballard scale. " 1996-2008 . drhull. com. 14 October 2008 <http://www. drhull. com/Ency/Master/B/Ballard. html>. "Nanda Nursing Diagnosis. " 2007. Right Health. 16 October 2008 <http://www. righthealth. com/Health/Nanda_Nursing_Diagnosis/-od-definition_wiki_Nursing_diagnosis-s>.

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