SAINT LOUIS UNIVERSITY
SCHOOL OF NURSING
BONIFACIO ST., BAGUIO CITY
Comparison of New Ballards Score and Parkins
Score for Gestational Age Estimation.
Dr. Kanchan Sakharkar, Dr. Sham Tarde, Dr. Sunil Mhaske
Submitted by:
Gedo Cruz, Maria Kyle Nicole R.
Submitted to:
Sir Blas Blasil Purganan
June 1,2018
I. Summary
In determining the gestational age of a neonate is very important since the age will
determine the ability of the neonate to adapt thus affecting his/her survival in this world. In this
study, the researchers have utilized two scoring techniques in determining the gestational age
of the child and aimed to determine which scoring is very much accurate and appropriate to the
new born.
The first scoring technique is the new ballard score includes physical criteria assessing
physical maturity and neuromuscular criteria assessing neuromuscular maturity. The physical
maturity is asses by skin, planter surface, lanugo, breast eye, ear, genitals male, genitals female.
The neuromuscular maturity includes Posture, Arm recoil, Square window test, Popliteal angle,
Heel to ear, Scarf sign. In sick infants or those in incubators, many of the neurologic criteria are
difficult to assess.
The second scoring technique is the Parkins Score which has 4 criteria (skin texture, skin
color, ear firmness and breast size).
To be able to determine the efficacy of the coring techniques, the study utilized a
prospective analytical type of clinical study. With a total population of 350 babies, all consents
given by their mothers. This study is done in tertiary hospitals. The screening tests was done by
2 different investigators, one for NBS and one for Parkins scoring. Data gathered was subjected
to Bland Altmann Plot. The mean standard deviation of the mean was found. The limits of
agreement were calculated using the formula: mean ± 1.96SD. The average of the two scores
was plotted against the difference between the two readings for each sample.
The results were obtained by the Bland Altmann plot which showed that there is a
similarity between the NBS and PS. Most of the values were within the limits of agreement.
Ballard score is more accurate than parkins score but in sick preterm babies new ballard score is
less preferable since parkins score is said to be simpler and easier to perform.
II. Nursing Implications
1. Nursing Practice – as a registered nurse in the future, it very important to learn and understand these
screening procedures and that to learn not only the basic principles in catering to the needs of the
newborn but also adjusting our interventions into their individual necessities. In relation to this journal, I
believe that we could use the Parkins Screening Test to determine the maturity of babies in a critical
stage to reduce further complications
2. Nursing Research – This study could be a reference for further enhancement of screening tests. And
hopefully we could come up with a more comprehensive yet less time-consuming screening tests to
determine the maturity of a newborn.
3. Nursing Education – I have now appreciated the relevance of each screening test. At first I did not
really understand it’s essence but now that I have understood how it works and its effects to the new
born, I have come to appreciate it and hopefully I can master the screening procedure.
III. References
Parkin JM, Hey EN Clowes JS. Rapid assessment of gestational age at birth,. Arch Dis Child. 1976;51:259-
63.
Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res.
1999;8: 135–60.
Farr V, Kerridge DF, Mitchell RG. The value of some external characteristics used in the assessment of
gestational age at birth. Dev Med Child Neurol. 1966; 8: 657-60.
Ballard JL, Novak KK, Driver M, A simplified score for assessment of fetal maturation of newly born
infants. J Pediatr. 1979; 95:769-74.
Lepley CJ, Gardner SL, Lubchenco LO. Initial nursery care: Assessment of gestational age. In: Merenstein
GB, Gardner SL, editors. Handbook of Neonatal Intensive Care. 3rd ed. St. Louis: Mosby Year
Book; 1993. p.76- 99.
