The Silverman-Anderson Score is a standardized clinical assessment tool used by healthcare professionals to evaluate the degree of respiratory difficulty in newborns. Developed in the 1950s, this non-invasive method provides an objective, numerical measurement of a baby’s breathing effort immediately after birth or when distress is suspected. Its primary purpose is to quickly quantify the severity of breathing problems, guiding the medical team toward appropriate interventions. The score focuses on specific physical signs that reflect the increased work of breathing, helping to differentiate between mild and life-threatening conditions.
Five Signs of Respiratory Effort
The assessment is based on observing five distinct physical signs, each reflecting the baby’s struggle to move air into their lungs. Each sign is assigned a score of 0, 1, or 2 points, with zero representing normal effort and two representing the greatest difficulty. The first sign, chest movement, assesses the synchronization between the chest and abdomen during inspiration. A score of two is given for a “seesaw” pattern, where the chest sinks as the abdomen rises, indicating profound breathing effort.
The next three components involve retractions, the visible pulling in of the skin and underlying tissues as the baby strains to breathe. These retractions are observed in the lower chest, between the ribs (intercostal), and at the bottom of the breastbone (xiphoid). When the lungs are stiff or air passages are blocked, the diaphragm pulls hard, drawing in the flexible parts of the chest wall. A score of one is for just visible retractions, while a score of two is for marked and constant indrawing.
The final two signs are nasal flaring and expiratory grunting. Nasal flaring occurs when the baby widens their nostrils during inhalation to decrease airway resistance and maximize air intake, scoring a two if it is marked and continuous. Expiratory grunting is an audible sound produced when the baby partially closes the vocal cords during exhalation to maintain pressure in the lungs, preventing the tiny air sacs from collapsing. Grunting audible without a stethoscope receives the maximum score of two points.
Translating the Score into Severity
By adding the points from all five observed signs, a total score is generated, ranging from zero to ten points. This number allows clinicians to translate physical observations into a defined level of respiratory compromise. A score of zero indicates that the baby is breathing normally with no signs of distress.
A total score between one and three points is interpreted as mild respiratory distress. Although the baby is showing increased effort, the condition is not immediately life-threatening and is often managed with close monitoring. Scores ranging from four to six points signify moderate respiratory distress, indicating a clear need for increased medical attention and intervention.
A score of seven or higher, up to the maximum of ten, is classified as severe respiratory distress or impending respiratory failure. This high score suggests that the baby’s current breathing effort is unsustainable and that the body is rapidly tiring.
Guiding Treatment Decisions
The Silverman-Anderson Score directly informs the immediate course of action for the medical team, providing a standardized framework for care. For a newborn scoring in the mild range (1-3), the primary intervention involves supportive care, such as continuous monitoring and supplemental oxygen. These babies typically need time and minimal assistance as their lungs adjust to breathing air.
A baby with a moderate score (4-6) requires more active intervention, often including positive pressure support. This is commonly delivered through Continuous Positive Airway Pressure (CPAP), which uses mild air pressure to keep the airways and lung sacs open, reducing breathing effort. Serial scoring tracks the baby’s response to treatment and determines if the condition is improving or worsening.
A score in the severe range (7-10) often warrants the most aggressive interventions to prevent complete respiratory failure. This level of distress may indicate the need for intubation and mechanical ventilation, where a machine breathes for the baby while the lungs heal. The score’s simplicity and speed make it particularly useful as a fast, bedside assessment in busy neonatal units or resource-limited settings.