Background: Chest physiotherapy (CPT) techniques are commonly employed to remove secretions in newborns undergoing mechanical ventilation for pneumonia. However, there is a lack of studies evaluating the impact of preextubation CPT on postextubation complications in pneumonia. Materials and methods: In this randomized controlled study, a total of 68 participants were randomly assigned to either the intervention or control group. Physiological parameters, including heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO₂), were compared between the two groups before CPT, immediately after CPT, and at 5 and 15 minutes following extubation. Additionally, diagnostic findings and the incidence of extubation failure were recorded before and after CPT. Results: The baseline characteristics of both groups were similar. Analysis of physiological parameters revealed nonsignificant changes in HR and RR in both groups. However, the intervention group showed a significant improvement in SpO₂ levels at 15 minutes postextubation (p = 0.030). Significant differences were observed between the two groups in the findings of auscultation (p = 0.018) and chest radiograph (p = 0.025). The control group exhibited a higher incidence of extubation failure, although the difference was not statistically significant (p = 0.052). Conclusion: Preextubation CPT is a safe and effective therapy option for newborns with pneumonia, regardless of their age or birth weight. It has the potential to reduce postextubation complications, as evidenced by improvements in physiological parameters and a lower incidence of extubation failure. Further research is warranted to explore the clinical implications and optimize the implementation of preextubation CPT in neonatal care.