Risk stratification in preterm neonates with sepsis: Evaluating feeding intolerance, ARDS and hemodynamic instability using neonatal scoring systems and antibiotic regimens

Al-Sebaie, Oubaida and Aldakhnoosh, Razan (2025) Risk stratification in preterm neonates with sepsis: Evaluating feeding intolerance, ARDS and hemodynamic instability using neonatal scoring systems and antibiotic regimens. World Journal of Biology Pharmacy and Health Sciences, 23 (1). pp. 208-216. ISSN 2582-5542

In areas with little medical care, neonatal sepsis continues to kill premature babies. This is particularly true in provider-short areas. The Jordanian Ministry of Health conducted research between those two years. This research examined whether birth grading systems and pharmaceutical interventions might accurately predict outcomes in 250 preterm newborns. The investigation aimed to determine how well these techniques predicted outcomes. It focused on the Neonatal Sequential Organ Failure Assessment (nSOFA), Clinical Risk Index for Babies (CRIB-II), and Neonatal Multiple Organ Dysfunction (NEOMOD) scores. This study sought to evaluate how well these ratings predict death and other problems. Meal difficulties, ARDS, and unstable blood flow were issues. Antibiotic treatments with a narrow spectrum (ampicillin and gentamicin) and a wide spectrum (meropenem and vancomycin) were tested for efficacy. The cohort had a mean gestational age of 31.2 weeks and a standard deviation of 2.5 weeks and a birth weight of 1580 grammes with a standard deviation of 420 grammes. Additionally, the group had an average gestational age of 31.2 weeks. Late-onset sepsis (LOS) affected 62% of patients, a significant rate. Total population mortality was 26.4%. Haemodynamic instability, acute respiratory distress syndrome, and nSOFA scores above 8 were strong indicators of death risk (adjusted odds ratio = 5.1, 95% confidence interval = 2.6–10.0). Research indicates a substantial correlation between food resistance and longer hospital stays (52.3% versus 32.6%, p = 0.01) and hospitalisations lasting over 28 days (p < 0.001). 44.8% of newborns were food-resistant. This number was significant. Thirty percent of the neonates had acute respiratory distress syndrome (ARDS), and 58.7% perished. For children without congestive heart failure (ARDS), the mortality rate was 18.5% (p < 0.001). The nSOFA score, with an AUC of 0.84 and a 95% CI of 0.78–0.90, was better at identifying probable fatalities. This score beat NEOMOD (AUC 0.79) and CRIB-II (AUC 0.71) in individual differentiation. Broad-spectrum antibiotics did not affect survival (25.5% vs 28.6% mortality, p = 0.15), although they did reduce recovery time for positive culture patients (5.2 days vs 7.8 days, p = 0.04). These factors influenced survival but did not substantially alter it. Our findings demonstrate the predictive power of organ dysfunction-focused scoring systems in preterm baby sepsis, particularly for nSOFA. However, dietary allergies, haemodynamic instability, and acute respiratory distress syndrome contributed to the tragic consequences. Only high-risk patients should get empirical broad-spectrum therapy, with a concentration on antimicrobials. Risk assessment tools in clinical settings may improve the pace and effectiveness of therapy for low-resource neonatal intensive care unit (NICU) newborns.