• Maintaining endotracheal intubation is critical to treating respiratory failure in newborns. To reduce accidental extubations in our neonatal intensive care unit, a prospective comparison of rates of extubation was made between two taping methods and whether or not a head restraint was used. One tape method was significantly better at preventing accidental extubations. Head restraint was not a benefit when used prospectively. Factors that preceded or were associated with accidental extubation included the time intubated, infant agitation, endotracheal tube suctioning, the infant turning its head, chest physiotherapy, loose tape, too short a tube between lip and adapter, weighing, and endotracheal tube taping. This information and the study design are valuable in developing strategies to minimize accidental endotracheal extubation and the subsequent risks of airway injury and subglottic stenosis in sick newborns.