Silverman-Andersen Retraction Score
5-component bedside scoring system for assessing severity of respiratory distress in neonates. Each item scored 0–2. Total score 0 = no distress; 10 = severe distress. Used to guide oxygen supplementation and ventilatory support decisions.
Score interpretation
Silverman-Andersen score 0 — no respiratory distress
→ Routine neonatal observation; ensure temperature stability and feeding; monitor closely in first hours of life especially in preterm or post-caesarean section infants
Silverman-Andersen score 1–3 — mild respiratory distress
→ Supplemental oxygen if SpO₂ <91%; consider nCPAP if symptoms persist or worsen; neonatal team review; continuous SpO₂ monitoring; check blood gas; CXR; blood cultures if infection suspected; repeat scoring every 30–60 min
Silverman-Andersen score 4–6 — moderate distress; respiratory support required
→ NICU/SCN transfer; nCPAP or HFNC; FiO₂ titration; blood gas monitoring; CXR; surfactant if RDS suspected in preterm; septic screen; senior neonatologist review; consider intubation if deteriorating
Silverman-Andersen score 7–10 — severe distress; urgent intervention required
→ Immediate NICU admission; endotracheal intubation and mechanical ventilation; surfactant administration for RDS; blood gas and CXR urgently; broad-spectrum antibiotics (GBS/gram-neg cover); senior neonatologist; consider pneumothorax, diaphragmatic hernia, PPHN as differentials; parental support and counselling
Interpretation bands for the Silverman-Andersen Score. Apply clinical judgement and local guidance.
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):1–10.
Related
Curated clinical cross-links plus same-class fallbacks.
- Poractant Alfa (Porcine Surfactant) · Lung Surfactant (Respiratory Distress Syndrome — Neonatal)
- Doxapram hydrochloride · Respiratory stimulant
- Cefuroxime · Second-Generation Cephalosporin — Respiratory / Surgical Prophylaxis
- Clarithromycin · Macrolide Antibiotic — Respiratory / H. pylori / MAC
- Respiratory syncytial virus (RSV) vaccine · RSV pre-fusion F protein vaccine
- Rozanolixizumab · Neonatal Fc receptor (FcRn) antagonist
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.