<p>In a retrospective observational study of prospectively collected data, we investigated whether systematic computerised data collection and analysis enable the safe introduction of advanced ventilation modes—volume guarantee (VG) and high-frequency oscillatory ventilation (HFOV)—into routine clinical care during emergency neonatal transport. Data were downloaded from ventilators during interhospital transport over an 8.5-year period. Ventilator parameters, waveforms and loops were reconstructed and discussed during case review meetings. The quality of respiratory care was assessed against a set of quality indicators for each year. Trends in ventilation practice were also analysed. A total of 1031 infants were included. The use of ventilation modes supporting all breaths increased from 38% in 2017–2020 to 56% in 2021–2025 (<i>p</i> &lt; 0.001). VG use increased during the first 2&#xa0;years (<i>p</i> &lt; 0.001) and subsequently remained stable at 82–87%. HFOV use increased from 2.6% in 2020 to 20.6% by 2025. pCO₂ after transport met the criteria in 87% of cases, with no significant change over the years. In infants ventilated without VG, the mean expired tidal volume was 4–6&#xa0;mL/kg in only 31% (52/166) of cases. A significantly (<i>p</i> &lt; 0.001) higher proportion of infants ventilated with VG were in this range (493/758, 65%). Ventilator alarms were active for 5.8% of the time.</p><p><i>Conclusion</i>: Advanced ventilation modes can be safely introduced into clinical use when accompanied by systematic data collection and analysis. Regular case reviews lead to practice development even without an explicit ventilation protocol.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> <p><b>What is Known:</b></p> <p><i>• Modern ventilators offering adaptive and advanced modes such as volume guarantee and high-frequency oscillatory ventilation are increasingly used during neonatal transport.</i></p> <p><i>• Their use during neonatal transfer has lagged behind their use in neonatal intensive care units.</i></p> </entry> </row> <row> <entry nameend="c2" namest="c1"> <p><b>What is New:</b></p> <p><i>• Advanced ventilation modes can be safely introduced into routine clinical care during neonatal transport with systematic collection and analysis of detailed ventilator data.</i></p> <p><i>• Regular structured case reviews using these data result in practice development even without an explicit ventilation protocol.</i></p> </entry> </row> </tbody> </tgroup> </Table></p>