Building on the successful implementation of the QI initiative at McMaster and our group’s previous research, this CIHR-funded study, conducted in collaboration with EPIQ, CNN, and 24 Canadian centres, will be a prospective comparative effectiveness study across participating tertiary NICUs in Canada. Centres will self-select whether to use higher or equal/lower pressure levels, as well as the initial post-extubation mode (NIPPV or CPAP), for the study duration. Only the first eligible extubation will be analyzed. Eligible patients will be <28 weeks’ gestational age at birth and undergoing an eligible extubation from a mean airway pressure ≤13 cmH₂O. The primary outcome will be re-intubation within 7 days, with secondary outcomes including other neonatal morbidities​​​​​​​​​​​​​