In extremely preterm infants less than 28 weeks gestation who are receiving invasive mechanical ventilation, does extubation to a higher level of continuous positive airway pressure compared to standard practice prevent deterioration and return to mechanical ventilation.

Infants will be extubated to a set Continuous Positive Airway Pressure (CPAP) level of 10 cm H2O. Whilst receiving CPAP, infants will remain within the set CPAP levels range of 9 cm H2O – 11 cm H2O for at least 24 hours, with changes to the set CPAP levels within this range at the discretion of the treating team. After 24 hours, infants may have their set CPAP level weaned at the discretion of the treating team, but must remain within a set CPAP level range 5 cm H2O – 11 cm H2O for at least 7 days after extubation if receiving CPAP. Infants will be re-intubated if they satisfy extubation failure criteria within 7 days after extubation, defined as: FiO2 requirement >0.20 above the pre-extubation FiO2, Two or more apnoeic episodes within any 24-hour period requiring intermittent positive pressure ventilation, or six or more apneoic events requiring stimulation in any 6-hour period, Respiratory acidosis with pH <7.2 and CO2 >60 mm Hg or urgent intubation for an acute deterioration. The fraction of inspired oxygen will be titrated to keep oxygen saturations in the standard target ranges of the enrolling hospital. Adherence to the study protocol will be monitored both by direct observation by study personnel as well as auditing of the individual medical records.