Which of the following is NOT a Silverman scoring parameter?

• A. Intercostal retractions
• B. Xiphoid retractions
• C. Chest lag/paradoxical breathing
• D. Sternal retractions

Answer: (D)

Silverman scoring evaluates neonatal respiratory distress by five observable signs: the pattern of chest movement (whether the upper chest moves in sync with the abdomen, shows a lag, or exhibits paradoxical/see-saw movement), retractions of the lower chest (intercostal), retractions at the xiphoid/subcostal area, nasal flaring, and expiratory grunt. Each sign is scored from 0 to 2, with higher scores indicating more severe distress. Sternal retractions are not a separate parameter in this scale. If a baby has chest movement abnormalities, they are captured under the chest movement category as lag or paradoxical breathing, while intercostal and subcostal retractions are assessed in their respective categories. Nasal flaring and expiratory grunt complete the remaining two signs. Therefore, sternal retractions are not part of the Silverman scoring parameters.