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Downes score (neonatal respiratory distress)

Also called Downe score, Downes RDS score, modified Downes score

Five-item (0–10) clinical score of respiratory distress in newborns of any gestation, used to start and escalate CPAP.

Respiratory rate
Retractions
Cyanosis
Air entry
Grunting

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Formula and scoring

Respiratory rate (<60 / 60–80 / >80) + retractions (none / mild / severe) + cyanosis (none / relieved by O₂ / on O₂) + air entry (good / mildly decreased / none) + grunting (none / with stethoscope / naked ear), each 0–2. <4 no/mild distress; 4–7 respiratory distress; >7 impending respiratory failure.

Exam and ward pearls

  • Downes is applicable at all gestations; Silverman–Andersen is used mostly for preterm infants.
  • The RDS-NExT consensus uses a Downes score of 4–7 as one of its surfactant criteria in preterm infants.

When not to rely on it

  • Published bands vary slightly between sources (some use 1–4 mild, 5–7 moderate); this calculator uses <4 / 4–7 / >7.
  • A score is no substitute for SpO₂, blood gas and chest imaging when available.

Source

  1. Downes JJ, Vidyasagar D, Boggs TR, Morrow GM. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid-base and blood-gas correlations. Clin Pediatr (Phila). 1970;9(6):325-31. doi:10.1177/000992287000900607 · PMID 5419441
  2. Singh R, Munian LP, Memela NA. Management of neonates with respiratory distress syndrome in resource-limited settings. S Afr Fam Pract. 2024;66(1):e1-e7 (Table 1 and score bands). doi:10.4102/safp.v66i1.5938 · PMID 38832392
  3. Bhandari V, Black R, Gandhi B, et al. RDS-NExT workshop: consensus statements for the use of surfactant in preterm neonates with RDS. J Perinatol. 2023;43(8):982-90. doi:10.1038/s41372-023-01690-9 · PMID 37188774

Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.

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