Dubowitz/Ballard scoring

The Dubowitz/Ballard score or rather scale in most cases is a technique used in assessing gestational age in infants. The Ballard score or rather Dubowitz assigns scores to various criteria that are divided into neurological and physical. This technique or rather scoring enhances the estimation of age ranging from 26 weeks to approximately 43 weeks. The paper in our case will narrow its discussion on Dubowitz/Ballard scoring based on an assignment of a 37 week GA infant. The paper will also include picture and measurement description of what is being scored and why it is used in gestational age determination.

From my assessment of the neuromuscular criteria, I am going to narrow down on the aspects such as the posture, square window, Arm coil, popliteal angle, scarf sign and heel to ear. On the other criteria that are the physical criteria, I am going to assess aspects such as skin, lanugo hair, breast bud, plantar surface, genitals and eye/ear.

Neuromuscular maturity

Posture. Under this case, it has the meaning of observing the infant’s posture, and this is greatly achieved by handling the infant that improves the assessment.

The square window is performed by flexing the hand at the wrist, and this enhances the exertion of pressure that leads to much flexion as possible or rather required. Also, the angle that is in between the anterior aspect of the forearm and hypothenar eminence is measured and later score.

Arm recoil as the other aspect of the neuromuscular criteria involves fully flexing the hands with the forearm with the hands at the shoulder during the process for approximately five seconds then followed by an extension by pulling the hands and release as soon as the elbows are extended fully and take heed of the recoil that is the degree at which the flexion is at the elbows.

The fourth aspect of the neuromuscular criteria is the popliteal angle that is achieved with the pelvis flat on the examining surface and bringing the knee onto the abdomen using one hand and the other side pushing behind the ankle bringing the foot towards the face.

The fifth stage is the scarf sign achieved by taking the infant’s hand and draw across the neck and the shoulder like a scarf and score according to the location of the elbow.

Heel to ear on the other side has the meaning of holding the infant’s foot with one hand and moving it closer to the head as possible remember not to force it.In the process of the practice, the knee may slide down the side of the abdomen as you proceed and ensuring that the pelvis is flat on the surface.

From the assessment, the following was as a result of the assessment on the infant’s gestationalage.

The second aspect in Dubowitz/Ballard scoring is the physical criteria.

Under the physical criteria the six features are going to be entered in the table below and analyzed as follows.

  -1 0 1 2 3 4 5
Lanugo None Sparse Numerous Thinning Bald areas Mostly bald Sparse
Skin Sticky, friable, transparent Gelatinous, red, translucent Smooth pink, visible veins Superficial peeling and rash, few veins Cracking, pale areas, rare veins Parchment, deep cracking, no vessels Leathery, cracked, wrinkled
Ear and eye Lids fused loosely: -1

Tightly: -2

Lids open pinna flat stays folded SI. Curved pinna soft; slow recoil Well-curved pinna soft but ready recoil Formed and firm instant recoil Thick cartilage ear staff  
Plantar surface Heel-toe 40-50 mm: -1<40mm: -2 >50 mm

No crease

Faint red marks Anterior transverse crease only Creases over anterior 2/3 of sole Creases over entire sole  
Breast Imperceptible Barely perceptible Flat areola no bud Stippled areola 1-2 mm bud Raised areola 3-4 mm bud Full areola 5-10 mm bud  
Genitals (female) Clitoris prominent and labia flat Prominent clitoris and small labia minora Prominent clitoris and enlarging minora Majora and minora equally prominent Majora large, minora small Majora cover clitoris and minora  
Genitals (male) Scrotum flat, smooth Scrotum empty, faint rugae Testes in upper canal, rare rugae Testes descending, few rugae Testes down, good rugae Testes pendulous, deep rugae  


The interpretation of the gestational age of the infant.

  1. Total score -10: Gestational age 19 weeks
  2. Total score 0: Gestational age 22 weeks
  3. Total score 10: Gestational age 25 weeks
  4. Total score 20: Gestational age 28 weeks
  5. Total score 30: Gestational age 31 weeks
  6. Total score 40: Gestational age 34 weeks
  7. Total score 50: Gestational age 37 weeks

From the ballard score we find that the scores were ranged from 5 to 50 with the corresponding gestational ages ranging from 19 weeks and 37 weeks where as the increase in the score by 10 increases the age by 3 weeks.on the other hand the new ballards score gives room for -1 hence there are negative scores.


From the above we come to get the aspect of dubowitz/ballards scoring put in use lleading to the well established infant’s geastational age assesments.from the article we also get to understand better the criteria which are much involved in the dubowitz score which are nnueromascular and physical criteria which involves numerous asppects under them.




Ballard, J. L., Khoury, J. C., Wedig, K. L., Wang, L., Eilers-Walsman, B. L., &Lipp, R. (1991). New Ballard Score, expanded to include extremely premature infants. The Journal of pediatrics, 119(3), 417-423.

Ballar, J. L., Novak, K. K., & Driver, M. (1979). A simplified score for assessment of fetal maturation of newly born infants. The Journal of pediatrics, 95(5), 769-774.