Newborn Transition Respiratory Scoring Tool

This respiratory scoring tool provides guidance to the delivery resuscitation teams caring for newborns at the University of Utah Hospital to help ensure the appropriate level of support for newborns with mild to moderate respiratory distress. The goals of this scoring tool include judicious use of continuous positive airway pressure (CPAP) to reduce iatrogenic complications (e.g., pneumothorax), allowing more neonates to transition with their mother, and preventing unnecessary admissions to the Neonatal Intensive Care Unit (NICU). The tool and care process were last updated in 2022.

Key Points

Infants 35 weeks and older
The tool applies to infants ages 35 weeks and older in the first 30 minutes of life with mild-to-moderate respiratory distress and equal breath sounds; apneic and non-vigorous infants and more premature infants are excluded. See Newborn Transition Care Guideline for more details.

Differs from APGAR
The elements of the tool differ from APGAR scoring in that they focus entirely on indicators of respiratory distress (respiratory rate, cyanosis, air entry, grunting, retractions, and nasal flaring).

Cut-off score
The tool uses a cut-off score of 4 or higher to prompt initiation of CPAP; newborns with scores <4 should be observed following normal transition protocols.

Transfer to NICU
Infants continuing to require CPAP after a total 10 minutes of effective CPAP should be transferred to the NICU for care.

No transfer to NICU
Infants with improved respiratory scores after a total of 10 minutes (or less) of CPAP can be cared for in the Transition Nursery.

Document use of the respiratory care tool in the electronic medical record.

Respiratory Scoring Tool

Transition Respiratory Tool for Infants
University of Utah Health

Care Process

Infant with Respiratory Issues Care Process
University of Utah Health


Information & Support

Related Portal Content

For Professionals

Transition Respiratory Scoring Tool PowerPoint (University of Utah)
An explanation of the University of Utah respiratory scoring tool, its background, and how to implement it in caring for newborns with mild to moderate respiratory distress.

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