Exploring the Effects of Prone Position Ventilation Combined with Drug on Clinical Outcomes in Neonates with ARDS: A Single-Center Retrospective Cohort Study

Chunyan Lin, Ting Huang, Huangyi Wu, Yanzhu Lin, Chunling Guo, Liduan Li NICU, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, People’s Republic of ChinaCorrespondence: Liduan Li, Email lyfjs7w8@163.comObjective: To evaluate the association of prone position ventilation combined with intravenous ambroxol versus conventional supine ventilation on clinical outcomes in neonates with acute respiratory distress syndrome (ARDS).Methods: Neonates with ARDS admitted to the Neonatal Intensive Care Unit (NICU) of the Second Affiliated Hospital of Fujian Medical University between January 2023 and December 2024 were included. A total of 80 neonates were allocated into two groups (n=40 each) based on a temporal shift in clinical practice: an Observation Group receiving prone positioning (target > 16 hours/day) plus intravenous ambroxol (7.5 mg/kg twice daily for 5 days), and a Control Group receiving supine ventilation alone. Both groups received standard lung-protective ventilation and co-interventions per protocol. The primary outcome was ventilator-free days (VFDs) to day 28.Results: The primary outcome, VFDs, was significantly higher in the observation group (median [IQR]: 18 [15– 21] days) than in the control group (14 [10– 17] days; P=0.003). The observation group also had a shorter duration of mechanical ventilation (mean difference: 2.04 days; 95% CI: 1.55 to 2.53; P< 0.001) and a shorter hospital length of stay (mean difference: 6.55 days; 95% CI: 5.61 to 7.49; P< 0.001). Physiological parameters improved more favorably in the observation group, with a significant Group × Time interaction for the Oxygenation Index (P< 0.001) and a lower peak inspiratory pressure at 72 hours (adjusted mean difference: − 1.95 cmH2O; 95% CI: − 2.45 to − 1.45; P< 0.001). The overall incidence of major complications was lower in the observation group (12.5% vs. 47.5%; Relative Risk: 0.26; 95% CI: 0.11 to 0.62; P=0.001).Conclusion: In this cohort, the combination therapy was associated with significantly improved respiratory outcomes and a lower complication rate in neonates with ARDS, suggesting it may be a beneficial adjunctive strategy. These findings warrant validation in a prospective randomized trial.Keywords: neonatal acute respiratory distress syndrome, prone position ventilation, drug therapy, combined therapy