Silverman-Andersen score
The Silverman-Andersen score quantifies the newborn’s respiratory distress from five parameters observed at the bedside. The higher the score, the greater the work of breathing. Assess each parameter and the calculator classifies the distress.
Assess the five parameters and choose the observed degree for each. Each parameter scores 0 to 2; the total ranges from 0 to 10.
The higher the score, the greater the distress. A score ≥ 5 usually indicates a need for respiratory support; some units classify ≥ 5 as severe. Reassess serially: the trend matters more than a single value.
Clinical decision-support tool for use by healthcare professionals. It does not replace clinical judgment or your unit's protocols.
Parameters
Thoracoabdominal movements, intercostal retraction, xiphoid retraction, nasal flaring and expiratory grunting. Each scores from 0 (absent or normal) to 2 (marked), for a total of 0 to 10.
Interpretation
0: no distress. 1 to 3: mild distress. 4 to 6: moderate. 7 to 10: severe. A score ≥ 5 usually indicates a need for respiratory support; some units already classify ≥ 5 as severe. A single value matters less than the trend: reassess serially.
Example
Preterm newborn at 34 weeks, 2 hours old: inspiratory lag of the chest (1), mild intercostal retraction (1), mild xiphoid retraction (1), mild nasal flaring (1) and grunting audible with a stethoscope (1). Score 5, moderate distress. Start CPAP per protocol and reassess in 30 minutes.
Frequently asked questions
Does the Silverman-Andersen score alone decide on CPAP or intubation?
No. It grades the work of breathing. The decision on support also considers respiratory rate, saturation, oxygen requirement, blood gases and the likely cause of the distress.
How often should it be reassessed?
In the first hours of a respiratory illness, every 30 to 60 minutes or at each change in support. The trend of the score guides escalating or weaning support.
Is the score valid for term newborns?
Yes. It was described in preterm infants, but it is used in any newborn with signs of respiratory distress, such as transient tachypnea and meconium aspiration.
References
- Silverman WA, Andersen DH. A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics. 1956;17(1):1-10.
- Brazilian Society of Pediatrics (SBP). Department of Neonatology. Respiratory distress in the newborn. Scientific document.
- Hedstrom AB, et al. Performance of the Silverman Andersen Respiratory Severity Score in predicting PCO2 and respiratory support in newborns. J Perinatol. 2018;38(5):505-511.
