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Respiratory distress in the newborn: signs, the Silverman–Andersen score and oxygen care

  • Assessment

The nurse spots the signs of hard breathing, scores them, measures saturation and gives oxygen only as prescribed and to target.

Updated

What it is

Respiratory distress is one of the most frequent problems in the first hours of life. Its causes range from a brief adaptation problem (transient tachypnoea) to surfactant deficiency in the preterm baby, meconium aspiration or infection. The nurse does not make the diagnosis, but the nurse sees the baby first and most often: counts the breathing, looks for the signs of effort, applies the Silverman–Andersen score, measures saturation, keeps the baby warm and calm, and gives oxygen or other support exactly as the doctor orders. The condition pages explain each disease.

Reference values

  • Normal newborn breathing rate: about 40 to 60 breaths per minute.
  • Transient tachypnoea usually starts in the first 1 to 2 hours and clears within 48 to 72 hours.
  • Respiratory distress syndrome of prematurity usually starts within minutes of birth and often worsens for 2 to 4 days before improving.
  • In a study of newborns scored within 1 hour of birth, a score of 5 or more was linked to more escalation of respiratory support in the next 24 hours.

What you need

  • A clock with a second hand and a stethoscope.
  • A pulse oximeter with a neonatal sensor.
  • An oxygen source with a blender, warming and humidification, and the prescribed device.
  • The unit's Silverman–Andersen form and the observation chart.

How to measure it (and why)

  1. Count the breaths for a full minute with the baby calm — newborn breathing is irregular and short counts mislead.
  2. Look for grunting, flaring, retractions and colour of lips and tongue — they show how hard the baby is working.
  3. Apply the Silverman–Andersen score with the unit's form and record it — gives a number the whole team can follow.
  4. Place the oximeter sensor on the right hand and read the saturation once the signal is stable — measures oxygenation objectively.
  5. Keep the baby warm, the neck neutral and handling to a minimum — cold and stress raise oxygen use.
  6. Give oxygen only as prescribed, warmed and humidified, and adjust it to the target range — avoids both low and excess oxygen.
  7. If the baby breathes too fast to feed, hold oral feeds and ask the team about feeding — prevents aspiration.
  8. Repeat the score and saturation at the times set and after every change — the trend matters more than one value.

How to read it

  • Transient tachypnoea: more frequent after a caesarean without labour, in early-term and late-preterm babies; usually needs only oxygen or short support.
  • Respiratory distress syndrome: mainly preterm babies; the team may use CPAP, surfactant or ventilation. Gentle handling, stable temperature and careful fluids are part of care.
  • A rising score, or a falling saturation on the same oxygen, means the baby is getting worse even if one sign looks better.
  • Distress can be the first sign of infection, so it is reported, not just treated with oxygen.

Next step: when to call for help

  • Call at once for apnoea, central cyanosis, or saturation below target despite the prescribed oxygen.
  • Call if the score rises, grunting persists or the baby tires.
  • Call if fast breathing stops the baby from feeding.
  • Call if distress appears in a baby with risk factors for infection.

Test yourself

Think of the answer, then tap the question to see it.

What does the Silverman–Andersen score assess?

Five signs of breathing effort in the newborn, from 0 (breathing comfortably) to 10 (severe distress).

When does Resolution 3280 ask for the Silverman–Andersen score?

When the newborn has breathing difficulty at 10 minutes of life.

Why is oxygen titrated to a saturation target in the newborn?

Because both too little and too much oxygen cause harm.

How long does transient tachypnoea of the newborn usually last?

It usually clears within 48 to 72 hours.

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Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Performance of the Silverman Andersen Respiratory Severity Score in predicting PCO2 and respiratory support in newborns: a prospective cohort study (J Perinatol 2018;38:505–511) (Hedstrom AB et al., via PubMed Central, 2018); Neonatal respiratory distress syndrome (MedlinePlus, U.S. National Library of Medicine, 2025); Transient tachypnea of the newborn (MedlinePlus, U.S. National Library of Medicine, 2025); Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018).

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Representative model, for educational purposes only.