In recent decades, less aggressive ventilatory practices have been favored in extremely preterm newborns (EPNB), as invasive ventilation (IV) is a major risk factor for bronchopulmonary dysplasia (BPD). However, these changes have not been accompanied by consistent improvements in the incidence of BPD. The aim was to evaluate changes in ventilatory practices and their association with morbidity in EPNB. A single-center retrospective study was performed over the last 2 decades (2001-2020) on all newborns (NB) born with less than 28 weeks requiring ventilatory support. A total of 249 NB were included. There were no statistically significant differences in median gestational age and birth weight between the two decades. There was a significant decrease in IV (p=0.007) and a significant increase in exclusively non-invasive ventilation (p=0.007) in the second decade. There was a significant decrease in the use of IV in the first 24 hours of life (p=0.002). There was a higher prevalence of BPD in the second decade (p=0.042), although there was no difference in the prevalence of severe BPD (p=0.614) or when BPD was adjusted for mortality (p=0.324). Duration of IV predicts the development of BPD with good accuracy (AUC=0.911, CI95% 0.849-0.973). Only gestational age seems to be an independent factor for BPD (aOR 0.683; CI95% 0.517-0.902). Despite the use of less aggressive ventilation techniques, with an increase in exclusive non-invasive ventilation, there was not the expected improvement in the prevalence of BPD. Changing ventilation practices will probably not be a sufficient measure to improve BPD in EPNB.