Silverman-Andersen Score Calculator
Score newborn respiratory distress with the Silverman-Andersen index — chest movement, intercostal and xiphoid retraction, nasal flaring and expiratory grunt — total 0–10 with severity.
How it works
Silverman-Andersen = upper chest movement + lower chest retraction + xiphoid retraction + nasal flaring + expiratory grunt, each 0–2; range 0–10 (higher is worse). 0 none · 1–3 mild · 4–6 moderate · 7–10 severe respiratory distress.
Silverman and Andersen (1956) described five signs of breathing effort in newborns, each scored 0–2. Unlike the Apgar score, a higher Silverman-Andersen score means more distress: 0 is a newborn breathing comfortably and 10 is the most severe distress. It is widely used in delivery rooms and neonatal units, particularly in Latin America and Spain, to grade respiratory distress and track the response to oxygen or CPAP; a score of 7 or more suggests impending respiratory failure.
Worked example
A newborn with inspiratory lag of the upper chest (1), just visible intercostal retraction (1), no xiphoid retraction (0), minimal nasal flaring (1) and no grunt (0) scores 3 / 10 — mild respiratory distress.
Frequently asked questions
Is a high Silverman score good or bad?
Bad. The opposite of Apgar: 0 means no distress and higher scores mean more respiratory distress. Scores of 7–10 indicate severe distress.
When is the Silverman-Andersen score used?
In the first minutes and hours after birth and repeatedly in newborns with breathing difficulty, for example from transient tachypnoea, respiratory distress syndrome or meconium aspiration.
What is the Downes score?
Another newborn respiratory score (respiratory rate, cyanosis, retractions, grunting, air entry) that is often used for older or term infants; the two scores are not interchangeable.
Related calculators
Clinical decision tool for education and for use by trained clinicians alongside clinical judgement — not a diagnosis and not a substitute for medical assessment. Scores validated in specific populations may not apply to every patient.