[Jeanne Ballard, U.S. neonatologist]
A system for estimating newborn gestational age by rating physical and neuromuscular characteristics of maturity. For infants born between 20 and 28 weeks' gestation, Ballard tools are more accurate than other systems of estimating gestational age. Six neuromuscular markers are assessed: posture, square window (degree of wrist flexion), arm recoil, popliteal angle (degree of knee flexion); scarf sign (ability to extend infant's arm across the chest past the midline); and heel-to-ear extension. Seven physical characteristics are also evaluated: skin; lanugo; plantar creases; breast; eye and ear; and genitals. Each factor is scored independently, and then an overall sum is used to determine the gestational age. The tool is most accurate if performed within the first 12 to 20 hr of life or as soon as the baby's condition stabilizes.
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