Background: Extubation transfers breathing responsibility from the ventilator to the patient. Neonatal
nurses play an important role in weaning and extubation of mechanical ventilation. The current study
aimed to evaluate the effect of instructional guidelines on nurses' performance regarding care of high risk
neonates undergoing extubation of mechanical ventilator. Design: A quasi experimental design was
utilized. Settings: The current study was conducted at Neonatal Intensive Care Units (NICUs) at
Pediatric Hospital and Maternity & Gynecological Hospital affiliated to Ain Shams University Hospitals.
Subjects: A convenience sample of 50 nurses working in NICUs and all high risk neonates (30) admitted
to NICU and extubated from mechanical ventilation during the data collection period. Tools: A pre-
designed questionnaire and Observation checklists were used to collect data in this study. Results: The
current study findings revealed that, after application of instructional guidelines and booklet
dissemination, the studied nurses showed highly statistically significant improvement in their satisfactory
knowledge and competent practices (p < 0.01). Conclusion: Application of instructional guidelines had a
highly statistically significant effect on the studied nurses' knowledge and practices regarding care of
high risk neonates undergoing extubation of mechanical ventilator. Recommendations: Training
program should be conducted for all nurses working in NICUs about care of high risk neonates
undergoing extubation of mechanical ventilator.