INTRODUCTION: Non-invasive respiratory support strategies have evolved to avoid bronchopulmonary dysplasia (BPD) in preterm infants. However, consensus on the best treatment strategy remains lacking. This study aims to investigate current practices and variations in primary respiratory support for extremely preterm neonates across neonatal intensive care units (NICUs) in the Netherlands. METHODS: A web-based questionnaire was distributed to neonatologists in the Netherlands. The survey covered aspects like the choice of respiratory support modalities, criteria for their application, and associated clinical practices. RESULTS: The response rate was 48.5 % (66/136). The majority used continuous positive airway pressure (CPAP) as primary respiratory support
73.8 % for infants with gestational age (GA) ≤26 wks and 88.9 % for infants with GA 26-28 wks. The most used alternative was non-invasive positive pressure ventilation (NIPPV). Significant variation was particularly found in NIPPV settings. Respiratory support during less invasive surfactant administration (LISA) varied per NICU between CPAP and NIPPV, but overall CPAP was preferred. Caffeine was administered in the delivery room into infants with GA ≤26 weeks (30.2 %) and GA between 26 and 28 weeks (22.2 %). Doxapram was avoided in the first week of life in 81 % of the infants, independent of their GA. CONCLUSION: The study highlights diverse practices in primary neonatal respiratory support in the Netherlands, with significant variation in NIPPV settings while there is uniformity in CPAP use, underscoring the need for cohesive guidelines and training to standardize care and improve outcomes for extremely preterm neonates.