Mechanical ventilation has changed dramatically over the past few years with the explosion of technology. Asynchronous breathing is extremely common in intubated newborn infants. Asynchronous breathing has been shown to be associated with short-term adverse effects such as delivery of inconsistent tidal volume and minute ventilation, hypercarbia, hypoxemic episodes, increased energy expenditure, increased need for sedation and paralysis, decreased venous return, increase in intraventricular hemorrhage and fluctuations in blood pressure. It is now feasible to deliver synchronized breaths with the currently available ventilators to most patients in the newborn intensive care unit. Synchronized ventilation with pressure support of each spontaneous breath is physiological, decreases the work of breathing imposed by the endotracheal tube and has been shown to avoid most of the problems associated with asynchronous ventilation.