Introduction: Neurally Adjusted Ventilatory Assist (NAVA) improves patient–ventilator synchrony using diaphragmatic electrical activity. However, its long-term impact on neurodevelopment in extremely preterm infants remains unclear. This study examined the association between NAVA management and neurodevelopmental outcomes. Methods: We retrospectively compared infants born at ≤27 weeks’ gestation who were admitted before (2016–2017, n=38) and after (2019–2021, n=44) NAVA implementation. The primary outcome was the developmental quotient (DQ) at 18 months, assessed using the Kyoto Scale of Psychological Development. Results: Comparing the pre- and post-implementation groups: median gestational age, 25.5 vs. 25.9 weeks (p=0.67); postmenstrual age at extubation, 30.6 vs. 32.1 weeks (p<0.001); NAVA use, 0% vs. 91%; and high-frequency oscillatory ventilation use, 74% vs. 46% (p=0.013). No significant differences were observed between the groups in corticosteroid use, bronchopulmonary dysplasia incidence, postmenstrual age at discharge, or home oxygen therapy. At 18 months, DQ scores were as follows in the pre- and post-implementation groups: Full Scale (83 vs. 89; p=0.32), Gross Motor (81 vs. 86; p=0.45), Cognitive/Adaptive (83 vs. 90; p=0.56), and Language/Social (71 vs. 88; p=0.109). Modified Checklist for Autism in Toddlers score was 3 in both groups (p=0.86). Multivariable analysis revealed that NAVA use (adjusted odds ratio [aOR] 2.99, 95% confidence interval [CI]: 1.14–7.81) and gestational age (aOR 1.59, 95% CI: 1.08–2.33) were associated with Full Scale DQ ≥85; whereas sex and birth weight standard deviation were not. Conclusion: Despite the prolonged tracheal intubation period, NAVA management was associated with improved neurodevelopment outcomes at 18 months.