Calculators · Paediatrics & Neonatology · Score
Silverman–Andersen respiratory severity score
Also called Silverman Anderson score, Silverman retraction score, RSS neonate
Five observed signs of respiratory effort (0–10) in newborns, especially preterm infants; higher is worse.
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Formula and scoring
Upper chest (synchronised 0 / lag 1 / see-saw 2) + lower chest retraction (none / just visible / marked) + xiphoid retraction (none / just visible / marked) + nares dilatation (none / minimal / marked) + expiratory grunt (none / stethoscope only / naked ear). Range 0–10; unlike Apgar, higher is worse.
Exam and ward pearls
- Silverman–Andersen is mainly used in preterm infants; Downes score is used across gestations.
- Remember the direction: Apgar 10 is best, Silverman 10 is worst.
When not to rely on it
- Inter-rater reliability is poor (ICC 0.34 among neonatologists and nurses), and nasal flaring is hard to judge with CPAP prongs or masks.
- There are no universally agreed severity bands; use it to track the same baby over time.
Source
- 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. PMID 13353856
- Brenne H, Follestad T, Bergseng H, Eriksen BH, Søraunet K, Grunewaldt KH. Inter-rater reliability of the Silverman and Andersen index—a measure of respiratory distress in preterm infants. PLoS One. 2023;18:e0286655 (Fig 1 reproduces the original grading chart). doi:10.1371/journal.pone.0286655 · PMID 37390074
- 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. doi:10.4102/safp.v66i1.5938 · PMID 38832392
Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.