Performance of the Silverman Andersen Respiratory Severity Score in predicting PCO2 and respiratory support in newborns: a prospective cohort study

Abstract

Objective:To determine if the Silverman Andersen respiratory severity score, which is assessed by physical exam, within 1 h of birth is associated with elevated carbon dioxide level and/or the need for increased respiratory support.Study design:Prospective cohort study including 140 neonates scored within 1 h of birth. We report respiratory scores and their association with carbon dioxide and respiratory support within 24 h.Results:Carbon dioxide level correlated with respiratory score (n = 33, r = 0.35, p = 0.045). However, mean carbon dioxide for patients with score <5 vs. ≥5 did not differ significantly (56 vs. 67, p = 0.095). Patients with respiratory scores ≥5 had respiratory support increased within 24 h more often than those with scores <5 (79% vs. 28%, p < 0.001).Conclusion:The Silverman Andersen respiratory severity score may be valuable for predicting need for escalation of respiratory support and facilitate decision making for transfer in low-resource settings.

Visual function scale for identification of infants with low respiratory compliance

“…Subsequently, all scoring items were provided from visual observations, which might be easily adopted for use of remote video diagnosis between primary and higher-level units. Unlike Hedstrom et al, who found modest correlation between the respiratory severity score and carbon dioxide levels of infants 8 the predictive performance of the Silverman scoring system for low C dyn was relatively poor in our current study. To improve the system, we dichotomized the scores for each item for more objective assessment.…”

“…Until recently, associations between these physical scores and quantitative measures of respiratory function remained unknown. Hedstrom and colleagues recently reported a modest correlation between the respiratory severity score and carbon dioxide levels of newborn infants, who were admitted to the neonatal intensive care unit (n Z 33, r Z 0.35, p Z 0.045), 8 highlighting the importance of validating clinical assessment tools using modern objective markers. The recent distribution of neonatal ventilators, which provide quantitative measures of respiratory function, may dramatically accelerate the interpretation process of subjective physical findings into an objective diagnosis.…”

The Promise of Clinical Decision Support Systems Targetting Low-Resource Settings

“…Within the realm of respiratory conditions, several CDSS in low-resource settings have existed such as the Silverman Anderson Respiratory Severity Score (RSS) [43] and the Downes Respiratory Distress Syndrome (RDS) Score. The first score was recently evaluated in a prospective study on 140 neonates and found to correlate well with partial pressure of carbon dioxide and increased respiratory support [44]. Despite these promising findings, these scores are limited in that they solely depend on respiratory effort.…”

The Silverman Andersen respiratory severity score can be simplified and still predicts increased neonatal respiratory support

“…A recent study by Hedstrom et al assigned the RSS to all neonatal intensive care unit (NICU) admissions in a United States facility and followed their respiratory course. Elevated RSS (>4) correlated with an increase in respiratory support in the subsequent 24 hours, suggesting it is a valuable screen for neonates with impending respiratory failure . Some components of the score, however, can be subtle to assess (such as degree of nasal flaring) or require a stethoscope, raising the question of if the score could be simplified to facilitate use in low‐resource settings.…”

“…An existing data set was used from the previously mentioned study of non‐intubated neonates obtained by convenience sampling from a level IV NICU . In that study, hospital assistants assigned a full RSS within 1 hour of birth.…”