All issues > Volume 26(3); 1983

Original Article

J Korean Pediatr Soc. 1983;26(3):228-236. Published online March 31, 1983.

Simplification of Ballard'S Scoring System in Clinical Estimation of Gestational Age in Newborn Infants.

Woong Heum Kim¹, Jung Hwan Choi¹, Chong Ku Yun¹, Yong Ik Kim¹

¹Department of Pediatrics，and Department of Preventive Medicine，College of Medicine， Seoul National University

Abstract

Clinically, it is often required to identify that neonates are small, appropriate, or large-for- gestational age, since the clinical course, outcome, and problems are quite different in each group of infants. For this, accurate estimation of gestational age is required in addition to birth weight. Several methods to assess the gestational age based on the physical and neurological char- acteristics of neonates have been developed and also there have been some trials to simplify them in order to make it easier for both clinician and infant. Author tried to simplify the Ballard’s maturity rating system by reducing the number of items while keeping its original precision. Three physicians assessed gestational age independently in 103 newborn infants who were born at obstetric ward of Seoul National University Hospital from March to August in 1982. The results were as follows: 1) The correlation coefficient between the gestation weeks estimated by Ballard* s method and that calculated from LMP was 0.844, and regression equation for the latter (X) against the former (Y) was Y=6.54+0.87X. 2) Individual items of Ballard’s system were compared for their predictiveness according to their correlation coefficients with gestational age by LMP and for interobserver agreement according to kappa statistics. Then 6 items of posture, arm recoil, scarf sign, lanugo, plantar crease and breast were selected by excluding 6 items which showed relatively low value in correlation and/or agreement. 3) In order to simplify further while keeping reasonable precision, combinations of 5 out of 6 items were compared for their predictiveness according to correlation coefficients between total scores of respective combinations and gestational age by LMP. In this comparison total score of posture, arm recoil, scarf sign, plantar crease and breast showed best correlation (R = 0.843). The total maturity score (simplified) was correlated with Y (gestational age by LMP) as dependent variable of X (maturity score). The linear regression equation was Y =25.62+0.77X. 4) According to linear regression equation above, simplified maturity rating was developed as Table 5.

Keywords :Gestational age; maturity rating; Ballard’s scoring system.