TABLE 4

Agreement and Validity of the Ballard Score

StudyYearStudy Setting and LocationGA of CohortSample SizeAssessment Version (Original or New Ballard )AgreementValidity
Correlation Coefficient (R) with Reference GAMean Difference (wk)SD of Mean Difference (wk)Bland-Altman 95% LOA ±1.96 SD (LL, UL) (wk)Percent Within 1 wkPercent Within 2 wkSensitivity Preterm <37 wk (%) (95% CI)Specificity Preterm <37 wk (%) (95% CI)<37 wk PPV<37 wk NPV
Ultrasound
 HICs
  Scher and Barmada601987NICU; Pittsburgh, PA23–30 wk by LMPa24Original Ballard1.352.62(−3.79, 6.49)56.569.6
  Alexander et al611992University Hospital; Charleston, SC28–44 wk by Ballard4193Ballard0.7972.297.183.294.6
  Sanders et al461991NICU; Baltimore, MD<1500 g; <37 wk110Ballard0.692.7022.745.4
  Smith et al621999University Hospital; Houston, TX<2500 g; 85% preterm82Ballard0.861.401.1585
  Dombrowski et al631992Women's Hospital; Detroit, MI24–43 wk38 318Ballard85.4
  Gagliardi et al641992NICUs, tertiary hospitals; Milano, Italy<37 wk; <2500 g227Ballard−0.211.7620.540.4
  Wariyar et al471997Newcastle, UK32–42 wk347Ballard0.571.31(−2.0, 3.14)
<30 wk105Ballard3.431.97(−0.43, 7.29)
<30 wk105New Ballard1.571.75(−1.86, 5.0)
  Ballard et al201991NICUs and nurseries; Cincinnati, OHAll GAs; 20−44 wk530New Ballard0.970.151.46
  Amato et al651991NICU; Bern, SwitzerlandAll preterm, LBW38Ballard (physical)
  LMIC
  Karl et al662015Health facilities; Madang, Papua New Guinea25.5–43.7 wk; 900–4250 g623Ballard0.350.862.41(−3.86, 5.57)39.092.021.097.0
668(External)0.3358.081.014.097.0
668(Neurologic)0.39(−3.57, 6.57)23.093.014.096.0
  Rosenberg et al512009Special Care Nursery; Dhaka, BangladeshPreterm, all <33 wk355Ballard−0.411.08(−0.7, 1.51)
  Lee et al402016Community; Sylhet, Bangladesh33–45 wk710Ballard0.12−0.402.22(−4.7, 4.0)32.06415.087.09.092.0
  Moraes and Reichenheim67 (translated)2000Maternity unit; Rio de Janeiro, BrazilNS116New Ballard57.0 (41.0 to 73.0)97.0 (90.0 to 99.0)
  Sreekumar et al682013NICU and postnatal wards; Bengaluru, India24–41.2 wk284New Ballard−0.04
  Wylie et al692013Ndirande Clinic; Blantyre, MalawiAll GAs177New Ballard0.802.19(−3.5, 5.1)
  Taylor et al702010Community; Keneba, The GambiaAll GAs80Ballard (external)−2.231.56(−5.3, 0.82)
  Thi et al712015General Hospital; Hoa Binh, Vietnam30–42 wk by ultrasound391New Ballard0.90
LMP
 HICs
  Baumann et al72 (translated)1993University Hospital; Bern, Switzerland27–35 wk AGA60Ballard (total)0.91
28–36 wk SGA290.66
27–35 wk AGA60Ballard (external)0.83
28–36 wk SGA290.66
27–35 wk AGA60Ballard (Neurologic)0.65
28–36 wk SGA290.66
  Constantine et al731987AK, NY, MA, FL, PA, TX, WA, CNAll GAs1246Ballard0.810.602.1885818975
(Physical)0.83−0.12.1492748787
(Neurologic)0.711.42.7270848960
  Scher and Barmada601987NICU; Pittsburgh, PA23–30 wk by LMP24Ballard1.422.32(−3.13, 5.96)45.862.5
  Mackanjee et al741996NICU; London, Ontario, Canada23–33 wk; <1500 g47Ballard0.871.501.50
  Dombrowski et al631992Women's Hospital; Detroit, MI24–46 wk38 818Ballard69.9
  Alexander et al751990Univerity Hospital; Charleston, SC20–45 wk10 794Ballard0.760.4852.780.3
  Ballard et al191979NICU and nursery; Cincinnati OH26–44 wk, 760–5460 g224Ballard0.85
  Alexander et al761992University Hospital; Charleston, SC28–44 wk; all African American population3480Ballard0.820.5368.2
28–44 wk; all white population2091Ballard0.860.1770.6
  Ballard et al201991NICUs and nurseries; Cincinnati, OH20–44 wk578New Ballard0.9688.0
  Ahn772008Neonatal units, university hospital; Incheon, South KoreaAll GA, 773–4870 g213New Ballardb0.850.46c
  Sanders et al461991NICU; Baltimore, MD<1500 g; <37 wk110Ballard0.662.602.228.251.0
 LMIC
  Cevit et al571998Tertiary care center; Sivas, TurkeyPreterm 28–38 wk; <2500 g91Ballard0.1059.398.9
  Feresu et al222002Maternity unit; Harare, Zimbabwe24–45 wk364Ballard0.80
(Physical)d0.75
(Neurologic)d0.74
  Sunjoh et al422004Tertiary Hospitals; Yaounde, Cameroon25–44 wk358New Ballard0.930.341.5286.0
  Bindusha et al332014Tertiary hospital; Kerela, India28–37 wk1000New Ballard0.920.31<36 wk: 85.6<36 wk: 94.6<36 wk: 98.0<36 wk: 53.6
  Sasidharan et al782009NICU; Northern India29–35 wk129New Ballard100.0
  Moraes and Reichenheim67 (translated)2000Maternity unit; Rio de Janeiro, BrazilNS140New Ballard68.0 (49.0 to 82.0)92.0 (85.0 to 96.0)
  Thi et al712015 General Hospital; Hoa Binh , Vietnam30–43 wk by LMP282New Ballard0.81
  Taylor et al702010Community; Keneba, The GambiaAll GAs76Ballard (external)−2.23.3(−8.67, 4.27)
  Verhoeff et al791997Tertiary Hospitals; Chikwawa District, MalawiAll GAs; literate mothers76Ballard (external)0.87
  • LL, lower limit; LOA, limits of agreement; NPV, negative predictive value; NS, not stated; PPV, positive predictive value; UL, upper limit; —, indicates that the data were not available for that paper.

  • a All infants in this study died; all deaths occurred after the assessments.

  • b This study used an “Extended New Ballard” scoring system to estimate GA (simply the standard New Ballard score extended to be used to estimate a greater GA range, which was calculated mathematically).

  • c For infants <39 wk GA. Mean difference = −0.58 wk for infants >39 wk GA.

  • d This study used a “revised” version of the physical and neurologic portions of the Ballard assessment.