Abstract: Objective: To observe the clinical efficacy of different maintenance doses of caffeine citrate combined with mechanical ventilation in the treatment of neonatal respiratory distress syndrome (NRDS),and explore new clinical emergency measures for NRDS. Methods: A total of 76 neonates with acute respiratory distress syndrome from July 2017 to June 2023 were selected,and divided into the observation group and control group (38 cases in each group).Two groups were respectively given different doses of caffeine citrate on the basis of mechanical ventilation treatment,and were given an initial dose of 20 mg/kg.After 24 hours,the maintenance dose for observation group was 10 mg/kg,and that for control group was 5 mg/kg for 5 days.The frequency and duration of apnea,mechanical ventilation time,total hospital stay,total hospitalization cost,changes in oxygenation index,serum inflammatory factors,bedside lung ultrasound findings and incidence of adverse reactions between two groups were compared. Results: Compared with the control group,the episodes of apnea,duration,ventilator usage time,length of hospital stay and total hospitalization cost in the observation group were lower(P<0.01).The levels of arterial oxygen saturation(SaO₂) and partial pressure of oxygen(PaO₂) in the observation group were higher than those in control group,while the level of partial pressure of carbon dioxide(PaCO₂) was lower than that in control group(P<0.01).The oxygenation index in two groups were improved after the intervention compared with that before intervention,and the effect of the observation group was better(P<0.05 to P<0.01).The levels of serum inflammatory factors in two groups decreased after medication,and which in the observation group was more significant(P<0.01).The lung ultrasound score in the observation group was lower than that in control group(P<0.01),and there were fewer abnormal ultrasound imaging manifestations(including abnormal A line,B line,white lung and lung consolidation),and the differences were statistically significance(P<0.01).There was no statistical significance in the total incidence of adverse events between two groups(P>0.05). Conclusions: The application of caffeine citrate maintenance at an initial dose of 20 mg/kg and a maintenance dose of 10 mg/kg combined with mechanical ventilation in the treatment of NRDS can significantly improve oxygenation in children,reduce the frequency and duration of apnea,alleviate systemic inflammatory responses and improve pulmonary lesions,while which can reduce the mechanical ventilation time,total hospital stay and total hospitalization costs.