Background Weaning of mechanical ventilation (MV), assessment of extubation readiness and provision of post-extubation support are critical steps in the care of extremely preterm infants (< 28 weeks). The use of evidence-based practices during the peri-extubation phase is paramount for ensuring successful outcome.

Objective Determine the peri-extubation practices used in extremely preterm infants internationally.

Methods From Oct 2013 to Feb 2014 a structured questionnaire with 15 questions related to peri-extubation practices was circulated to the clinical directors of 162 neonatal intensive care units across Canada, USA, Ireland, Australia and New Zealand.

Results 112 directors responded to the questionnaire (69%). The majority of units do not have written protocols for any aspect of MV (64%). The decision to extubate is generally made by the attending neonatologist (99%) or neonatal fellows (71%), based on ventilator settings, blood gases and haemodynamic stability; 16% of units extubate infants based on Spontaneous Breathing Trial (SBT). The SBT’s varied on definitions of failure and durations; from <5 min (59%) to >10 min (35%). The majority of infants are extubated ≤3 days of life (76%) to nasal CPAP (84%). The failure rate was estimated to be 10–30%, but there was lack of consensus on the definition of failure (re-intubation within 24, 48 or 72 h after extubation). The decision to reintubate was almost always based on clinical judgement of physicians (88%), rather than well defined re-intubation criteria.

Conclusions Peri-extubation practices in extremely preterm infants are not always evidence based and frequently physician-dependent. High quality trials are required to inform guidelines and standardise practices for this important aspect of neonatal intensive care.