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

Setty, Shubha; Batra, Maneesh; Hedstrom, Anna B.

doi:10.1111/apa.15142

Cited by 9 publications

(6 citation statements)

References 2 publications

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“…Before the application of LUS, we relied on symptom‐based methods to predict respiratory support needs. Current tools include the Silverman score 9,31 and the ACoRN score 10 . The Silverman score focuses on inspiratory retraction (the anterior chest wall, the lateral chest wall, and the xiphoid process), dilatation of the nares, and expiratory grunting.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound performed shortly after birth can predict the respiratory support needs of late preterm and term infants: A diagnostic accuracy study

Dai

Wang

et al. 2021

Pediatric Pulmonology

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Background Late preterm and term infants may develop respiratory issues with severe outcomes. Early identification of these diseases shortly after infants' birth can improve their management. Lung ultrasound (LUS) has been used to diagnose neonatal respiratory diseases. However, few LUS methods have been reported to predict the need for respiratory support, the basis of infant respiratory diseases management. Methods We conducted a prospective diagnostic accuracy study following the Standards for the Reporting of Diagnostic Accuracy Studies guidelines at a tertiary academic hospital between 2019 and 2020. A total of 310 late preterm and term infants with mild respiratory symptoms were enrolled. The LUS assessment was performed for each participant at one of the following times: 0.5, 1.0, 2.0, or 4.0 h after birth. Predictive reliability was tested by receiver operating characteristic curve analysis. The main outcome was the need for any respiratory support determined according to international guidelines. Results Seventy‐four infants needed respiratory support, and 236 were healthy according to a 3‐day follow‐up confirmation. Six LUS imaging patterns were found. Two “high‐risk” patterns were strongly correlated with respiratory support needs (area under the curve [AUC] = 0.95; 95% confidence interval [CI]: 0.92–0.98, p < .001). The optimal cut‐off value for “high‐risk” patterns was 2 (sensitivity = 87.8% and specificity = 91.1%). The predictive value of LUS was greater than that of a symptom‐based method (the Acute Care of at‐Risk Newborns assessment score) (AUCs' p < .01). Conclusions LUS can be used to predict the need for respiratory support in late preterm and term infants and is more reliable than tools based on respiratory symptoms.

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Section: Methodsmentioning

confidence: 99%

Ultrasound performed shortly after birth can predict the respiratory support needs of late preterm and term infants: A diagnostic accuracy study

Dai

Wang

et al. 2021

Pediatric Pulmonology

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“…In line with this finding, signs of increased work of breathing, apnea, or respiratory acidosis together with an increased oxygen need despite presumed optimized CPAP or positive endexpiratory pressure are used as pointers toward respiratory failure. 50 In an even more immature preterm infant population, these limitations in our diagnostic repertoire and their impact on therapeutic decisions must not be underestimated. One cannot help but argue that these clinical signs are merely confirming CPAP failure, rather than providing useful information toward its prevention.…”

Section: Surfactant Deficiency: Primary Driver Of Niv Failure In the ...mentioning

confidence: 99%

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

Wright

Glaser

Speer

et al. 2022

The Journal of Pediatrics

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“…Among very low birth weight infants (birth weight 500–1500 g) admitted to tertiary Nigerian NICUs, an increase in Downes' score was independently associated with adjusted odds of in‐hospital mortality (aOR 1.27, 95% CI 1.14–1.41) 12 . An area of future research is evaluation of further simplifying these objective scores 16 and the inclusion of current objective scores into risk estimators with the addition of patient‐level risk factors, such as gestational age and birth weight, 17 with the goal of supporting multi‐disciplinary care teams, standardising and improving team communication, and empowering bedside care providers.…”

Section: Discussionmentioning

confidence: 99%

High inter‐rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress

Ehret,

Demtse Gebremedhin,

Hadgu Berhe

et al. 2023

Acta Paediatrica

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AimTo assess the inter‐rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score‐based treatment for preterm infants with respiratory distress.MethodsWe included preterm infants admitted from June 2020 to July 2021 to four tertiary neonatal intensive care units (NICUs) of the Ethiopian Neonatal Network that presented with respiratory distress. We calculated the kappa statistic to determine the nurse and physician correlation for each component of the modified Downes' score and total score on admission and evaluated the concordance of scores above and below the treatment threshold of 4.ResultsOf the 1151 eligible infants admitted, 817 infants (71%) had scores reported concurrently and independently by nurse and physician. The kappa statistic for modified Downes' score components ranged from 0.88 to 0.92 and was 0.89 for the total score. There was 98% concordance for score‐based treatment.ConclusionIncorporation of the modified Downes' score on admission for preterm infants with respiratory distress was feasible in tertiary NICUs in Ethiopia. The kappa statistics showed near‐perfect agreement between nurse and physician assessments, translating to a very high degree of concordance in score‐based treatment recommendations. These results highlight an opportunity for task‐shifting assessments and empowering nurses.

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

Cited by 9 publications

References 2 publications

Ultrasound performed shortly after birth can predict the respiratory support needs of late preterm and term infants: A diagnostic accuracy study

Ultrasound performed shortly after birth can predict the respiratory support needs of late preterm and term infants: A diagnostic accuracy study

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

High inter‐rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress

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