Downes–Vidyasagar Score to assess the severity of respiratory distress in newborns

The Downes Score (also known as the Downes–Vidyasagar Score) is a bedside clinical scoring system used to assess the severity of respiratory distress in newborns, especially in settings without immediate blood gas access.

It’s applicable to both preterm and term neonates, and is commonly used in NICUs, special care baby units, and emergency settings to:

  • Grade respiratory distress
  • Monitor response to treatment (e.g. CPAP, oxygen, surfactant)
  • Help decide when escalation (e.g. CPAP, ventilation, referral) is needed
Downes Score – Respiratory Distress in Newborn

Downes Score – Respiratory Distress in Newborn

Assesses severity of neonatal respiratory distress using the Downes–Vidyasagar clinical score (0–10).

For use by neonatal health professionals only. This tool is a structured aid and does not replace full clinical assessment, pulse oximetry, blood gases, imaging, or local treatment protocols.

Enter clinical findings

1. Respiratory rate (breaths per minute)
Count for a full 60 seconds; include tachypnea and apnoeic episodes where present.
2. Cyanosis
Assess clinically and/or with pulse oximetry; consider oxygen supplementation.
3. Air entry
Auscultate both lungs; compare symmetry and intensity of breath sounds.
4. Grunting
Expiratory grunt; note if heard only on auscultation or also without stethoscope.
5. Retractions / chest indrawing
Observe intercostal, subcostal, suprasternal, and sternal recession.
Result

Total Downes Score: / 10

Severity: Not yet calculated

Select categories for all five parameters, then click “Calculate Downes Score” to see the total and severity band.

Typical interpretation: 0–3 = mild respiratory distress; 4–6 = moderate; ≥7 = severe, often warranting urgent escalation (e.g. CPAP, ventilation, referral) as per local guidelines. Always integrate with pulse oximetry, blood gases, chest X-ray, and underlying diagnosis (TTN, RDS, MAS, sepsis, PPHN, etc.).

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