Silverman–Andersen Retraction Score
Calculator for grading respiratory distress in newborns (0–10). For clinical use by trained professionals.
Observations
Select one option per category. Each item scores 0–2. Total = 0–10.
The Silverman–Andersen Retraction Score (SAS)—also called the Silverman–Andersen Respiratory Severity Score—is a quick bedside tool used to grade respiratory distress in newborns by observing visible signs of increased work of breathing. It was originally described in the 1950s (1956) and remains widely used because it’s fast, non-invasive, and does not require equipment. PMC+1
What it measures
SAS scores five clinical signs, each rated 0 (normal) to 2 (worst), for a total from 0 to 10: newbornwhocc.org+1
- Upper chest movement (synchrony of chest with abdomen)
- Lower chest retractions (intercostal retractions)
- Xiphoid retractions
- Nasal flaring
- Expiratory grunt
How to interpret the total score
Common clinical interpretation bands are:
- 0: No respiratory distress
- 1–3: Mild distress
- 4–6: Moderate distress
- 7–10: Severe distress (many references also flag ≥7 or >6 as concerning for impending respiratory failure, depending on the protocol) Wiley Online Library+2vghtc.gov.tw+2
SAS is typically used for trending over time (e.g., worsening retractions or new grunting), and as a standardized way for teams to communicate severity—always alongside oxygenation, perfusion, gestational age, and the full clinical picture.
