This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Assessing breathing difficulty in a newborn
Respiratory distress is one of the most common reasons for a newborn to need care in the first hours of life. Causes include transient tachypnea, respiratory distress syndrome in preterm babies, infection and meconium aspiration. The Downes score, described by John Downes in 1970, grades its severity at the bedside so that the response can be matched to it and the course followed over time.
The five signs
| Sign | 0 | 1 | 2 |
|---|---|---|---|
| Respiratory rate | under 60/min | 60 to 80/min | over 80/min or apnea |
| Cyanosis | none | in room air, relieved by up to 40% oxygen | needs more than 40% oxygen |
| Retractions | none | mild | moderate to severe |
| Grunting | none | audible with a stethoscope | audible without a stethoscope |
| Air entry | clear | decreased or delayed | barely audible |
The total ranges from 0 to 10.
Interpretation
| Score | Severity | Usual response |
|---|---|---|
| 1 to 3 | Mild distress | Close monitoring, sometimes oxygen |
| 4 to 7 | Moderate distress | Oxygen or CPAP, blood gas |
| over 7 | Severe | Impending respiratory failure: ventilatory support |
Example
A baby breathing at 70 per minute (1), pink in room air (0), with mild retractions (1), grunting heard only with a stethoscope (1) and decreased air entry (1) scores 4: moderate distress.
Downes or Silverman?
The Silverman-Andersen score, more common in preterm infants, grades the work of breathing (chest movement, retractions, nasal flaring, grunting) but not the respiratory rate or cyanosis. The Downes score is often preferred for term and late preterm babies. Both are repeated regularly, since the trend matters more than a single value.
A score is a support for clinical judgment, not a substitute: any newborn with signs of distress needs assessment by a pediatric team.