Clinical severity and gas-exchange associations in preterm neonates with respiratory distress syndrome

Background: Respiratory distress syndrome (RDS) is a leading cause of morbidity and mortality in preterm neonates. Early identification of disease severity using simple bedside tools and arterial blood gas (ABG) analysis may guide clinical decision-making and improve outcomes.Objective: To evaluate the correlation between the Silverman–Anderson clinical severity score and arterial blood gas parameters in preterm neonates with RDS.Methods: This cross-sectional study was conducted at the Neonatal Intensive Care Unit, Beni-Suef University Hospital, Egypt. Ninety preterm neonates with clinically and radiologically confirmed RDS were included. Baseline data collected included the Silverman–Anderson score and ABG parameters (pH, PaO₂, PaCO₂, HCO₃⁻). Correlations were analyzed using Pearson’s or Spearman’s tests, as appropriate.Results: The mean gestational age of the cohort was 32.6 ± 2.6 weeks, with a mean birth weight of 2334.9 ± 473.3 g. Baseline ABG values included a mean pH of 7.38 ± 0.09, PaCO₂ of 28.3 ± 7.4 mmHg, PaO₂ of 35.1 ± 5.2 mmHg, and HCO₃⁻ of 17.4 ± 5.2 mmol/L. The Silverman–Anderson score demonstrated significant negative correlations with pH (r = –0.541, p < 0.001) and PaO₂ (r = –0.291, p = 0.005), and a positive correlation with PaCO₂ (r = 0.265, p = 0.012). No significant correlation was observed with HCO₃⁻ (p = 0.413).Conclusion: The Silverman–Anderson score correlates strongly with acid–base and gas exchange disturbances in preterm neonates with RDS, supporting its role as a reliable, non-invasive tool for assessing clinical severity at the bedside.