Ballard JL et al. 1991. Public Domain

New Ballard Score

Estimate gestational age from 6 neuromuscular + 6 physical maturity criteria. Validated for newborns including extremely premature infants (<26 weeks).

Neuromuscular Maturity

Each criterion scored −1 to +5. Select the option that best describes the infant.

1
Posture
2
Square Window (wrist flexion angle)
3
Arm Recoil
4
Popliteal Angle
5
Scarf Sign
6
Heel to Ear

Physical Maturity

Each criterion scored 0 to +5 (or −1 for extremely premature skin). Select the option that best describes the infant.

7
Skin
8
Lanugo
9
Plantar Surface
10
Breast
11
Eye / Ear
12
Genitals (sex-specific. Select infant's sex first)
Your data never leaves this device. No accounts. No servers. No tracking.

Frequently Asked Questions About the New Ballard Score

The New Ballard Score (NBS) is a validated neonatal assessment tool for estimating gestational age based on physical and neuromuscular maturity. It was published by Ballard JL et al. in 1991 and expanded the original 1979 Ballard score to include extremely premature infants (as early as 20 weeks GA).

It consists of 12 criteria. 6 neuromuscular (posture, square window, arm recoil, popliteal angle, scarf sign, heel-to-ear) and 6 physical (skin, lanugo, plantar surface, breast, eye/ear, genitals). Each scored −1 to +5. Total score maps to estimated gestational age.

The NBS is ideally performed within the first 12–96 hours of life. Assessment before 12 hours may underestimate neuromuscular maturity (tone and flexion continue to recover from birth). Assessment after 96 hours may overestimate GA due to increasing tone with postnatal adaptation. Accuracy is ±2 weeks in most clinical settings.

The NBS is accurate to approximately ±2 weeks of gestational age in trained hands. It has the highest accuracy when performed by experienced examiners between 12–96 hours of life. First-trimester ultrasound remains the most accurate method of gestational age determination when available. The NBS is most useful when prenatal dating is uncertain or unavailable.

The New Ballard Score ranges from −10 to +50. Each 5-point increment corresponds to approximately 2 weeks of gestational age:

  • Score −10 to −5: ~20 weeks
  • Score 0–5: ~24 weeks
  • Score 10–15: ~28 weeks
  • Score 20–25: ~32 weeks
  • Score 30–35: ~36 weeks
  • Score 40–45: ~40 weeks
  • Score 45–50: ~42 weeks

Factors that can reduce accuracy include: sedated or ill infants (reduced tone), growth restriction (may appear more mature than actual GA), timing of assessment (too early or too late), examiner experience, and infants with neuromuscular disorders. The NBS should not substitute for reliable first-trimester ultrasound dating when available.