Key PointsQuestionIs nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV), or noninvasive high-frequency oscillatory ventilation (NHFOV) more beneficial in reducing invasive mechanical ventilation (IMV) in neonates?FindingsThis secondary analysis of a randomized clinical trial involving 1137 neonates found that neonates receiving NIPPV or NHFOV had fewer reintubations (range, −28% to −15%), fewer early (within 48 hours after extubation) reintubations (range, −24% to −20%), and shorter duration of IMV (range, −5.0 to −2.3 days) than those supported with NCPAP.MeaningThese results suggest that NIPPV and NHFOV are essentially similar, and better than NCPAP, in terms of reintubation and duration of IMV in extremely preterm neonates and those with more severe respiratory failure.