At what time frame is it best to perform a Ballard Assessment on an infant that was breech?

This is a very pertinent question, as the newborn who was frank breech (legs straight up) will have transient flexor fatigue in both the hamstrings and gluteus muscles. This will result in significantly lower scores for the popliteal angle and the heel to ear criteria, respectively.

In such a case, you have two options:

  1. Perform the remainder of the neuromuscular criteria, then assign a similar score to the popliteal angle and heel to ear.
  2. Wait 24 to 48 hours or until flexor tone has returned to the hamstrings and gluteus muscles, and repeat the assessment.

(These infants are also at risk for hip instability or dislocation.)

In cases of complete or footling breech, there should be no flexor fatigue of said muscles. Thus, the assessment should be valid in the usual time frame ( from 30 minutes to 96 hours of postnatal age).

Dr. Ballard

References :
Ballard JL, Khoury JC, Wedig K, et al: New Ballard Score, expanded to include extremely premature
infants. J Pediatrics 1991; 119:417-423.