Background: Respiratory complications are a major contributor to neonatal 
morbidity and mortality, particularly in developing countries. These issues are 
predominantly observed in premature neonates and frequently include conditions such as 
respiratory distress syndrome (RDS) and pneumonia, often necessitating ventilatory 
support or supplemental oxygen. Purpose: To compare the effect of reflex rolling and 
lung squeezing techniques on pulmonary functions in premature neonates with 
pneumonia. Methods: Neonates were randomly assigned into two equal groups from 
both sexes with 12 neonates in each group. (Group A and B), both groups received a 
specific physical therapy program for 15 min., while Group (A) received a reflex rolling 
technique and Group (B) received a lung squeezing technique. For two successive 
weeks, the intervention program was implemented for 20 min, two sessions/day, five 
times a week for both groups. The severity of respiratory distress was measured using 
the Silverman-Andersen Scale, Respiratory Rate was measured using a monitor (Hunt 
Leigh Healthcare /United Kingdom) at baseline and after two weeks of intervention for 
both groups and the period of hospitalization was determined by subtracting the date of 
starting physical therapy program from the date of discharge. Results: At the beginning 
of the intervention, there were no statistically significant differences between the two 
study groups (P > 0.05). However, following two weeks of intervention, both groups 
exhibited significant improvement in all the variables including; the severity of 
respiratory distress and the respiratory rate at discharge as compared to the measured 
admission values. Furthermore, the Lung Squeezing group had a noticeably decreased 
period of hospitalization (P < 0.05) compared to the Reflex Rolling group. Conclusion:
The present study concludes that reflex rolling and lung squeezing are effective methods
in improving all outcome measures in preterm neonates with pneumonia with favoring 
for the lung squeezing method in reducing the period of hospitalization, and both 
techniques can be applied safely in clinical settings