We read with interest the study on a quality improvement (QI) initiative for extubation in newborns [1]. Failed extubation is a common problem faced by healthcare workers across all neonatal intensive care units [2,3] and a QI initiative designed to improve this is a welcome step. We have two observations regarding this reasonably well- conducted study.

Authors have stated that ethical approval was not obtained as this study was a quality improvement initiative. Multiple articles have questioned this approach of not obtaining ethics approval for QI studies [4,5]. We feel ethics committee approval should be sought for all QI studies when it directly impacts patient care.

Secondly, authors have not specified if they have calculated sample size, as primary objective was to reduce extubation failure rates by 25% from baseline.

In Table I of the article, extubation failure in PDCA-1 is mentioned as 23.8% (5/21) while in figure 2 it is mentioned as 10/21. The other two categories ie, baseline and PDCA-2 figures are appropriate.

1. Prasad R, Mishra AK. Improvement in successful extubation in newborns after a protocol driven approach: A quality improvement initiative. Indian Pediatr. 2019;56:749-52.

2. Sinha S, Donn S. Weaning from assisted ventilation: art or science? Arch Dis Child Fetal Neonatal Ed. 2000;83: F64-70.

3. Saikia B, Kumar N, Sreenivas V. Prediction of extubation failure in newborns, infants and children: brief report of a prospective (blinded) cohort study at a tertiary care paediatric centre in India.　Springerplus. 2015;4:827

4. Flaming D, Barrett-Smith L, Brown N, Corcoran J. "Ethics? But it’s only quality improvement!". Healthc Q.　2009;12:50-5.