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Exploring the Effects of Prone Position Ventilation Combined with Drug on Clinical Outcomes in Neonates with ARDS: A
Chunyan Lin1, Ting Huang1, Huangyi Wu1
1NICU, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, People's Republic of China.
Objective:
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.
