How it's calculated
Five signs of respiratory distress are each scored 0 (none), 1 (moderate), or 2 (severe), and summed for a total of 0-10. Higher scores indicate greater work of breathing.
Scoring detail
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Chest movement | Synchronised | Lag on inspiration | See-saw (paradoxical) |
| Intercostal retraction | None | Just visible | Marked |
| Xiphoid retraction | None | Just visible | Marked |
| Nasal flaring | None | Minimal | Marked |
| Expiratory grunt | None | Audible with stethoscope only | Audible without a stethoscope |
Score bands
| Total score | Interpretation |
|---|---|
| 0 | No respiratory distress |
| 1–3 | Mild respiratory distress |
| 4–6 | Moderate respiratory distress |
| 7–10 | Severe respiratory distress / impending respiratory failure |
Clinical use
- Used to assess and trend respiratory distress in a newborn after birth — unlike APGAR (a one-time score at birth), Silverman-Andersen is repeated over time to track the trajectory of respiratory effort.
- A rising score over serial assessments suggests worsening respiratory status and may prompt escalation of respiratory support.
- Complements, rather than replaces, other markers such as oxygen saturation and blood gas when deciding on respiratory support.
Frequently asked questions
What is the Silverman-Andersen score used for?
It assesses the severity of respiratory distress in a newborn by scoring 5 signs of increased work of breathing, and is repeated over time to track whether respiratory status is improving or worsening.
How is Silverman-Andersen different from APGAR?
APGAR is a one-time assessment at 1 and 5 minutes after birth covering multiple domains (heart rate, respiratory effort, tone, reflex, colour). Silverman-Andersen focuses specifically on respiratory distress and is designed to be repeated over the following hours to trend respiratory effort.
What does a score of 7 or higher mean?
A score in the 7-10 range indicates severe respiratory distress, potentially with impending respiratory failure, and generally warrants prompt escalation of respiratory support and senior/neonatology review.
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;17:1-10.