<![CDATA[Respiratory distress in neonates, particularly preterm infants, is associated with pulmonary immaturity and a high need for respiratory support. Prone positioning is a supportive intervention that may improve oxygenation and respiratory mechanics; however, findings across studies remain inconsistent. This systematic literature review (SLR) aimed to synthesize the effectiveness of prone positioning in improving respiratory distress, oxygenation, physiological responses, hemodynamic stability, and safety outcomes in neonates. The SLR followed the PRISMA 2020 principles through searches of PubMed/MEDLINE and Google Scholar for primary studies published in Indonesian or English between 2013 and September 2026. The population included neonates, particularly preterm infants with respiratory distress or receiving respiratory support. A total of 25 primary studies were analyzed using narrative and thematic synthesis due to heterogeneity in study designs, neonatal characteristics, types of respiratory support, duration of prone positioning, and outcomes. The synthesis indicated that prone positioning tended to increase SpO₂ and improve several oxygenation and respiratory mechanics indicators, including tidal volume, PaCO₂, FiO₂, oxygenation index, lung aeration, and diaphragmatic workload. However, its effects on respiratory rate, heart rate, duration of respiratory support, and hemodynamic parameters were inconsistent. Prone positioning may also affect apnea, bradycardia, desaturation, cerebral oxygenation, comfort, and sleep, highlighting the need for close monitoring. Evidence integrating clinical respiratory distress indicators, oxygenation, hemodynamics, and comfort within a single protocol remains limited. Therefore, prone positioning has potential as a supportive nursing intervention, but its application should be individualized and accompanied by standardized physiological monitoring.]]>
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