Background: Endotracheal-suctioning is probably one of the most common invasive procedures performed in ne0onates with an artificial airway. Aim: Evaluate the impact of evidence based recommendations about open endotracheal tube suctioning on nurses' performance in neonatal intensive care units. Design: A quasi-experimental design was used. Setting: The study was conducted at neonatal intensive care unit of Suez Canal University hospital and neonatal intensive care unit of Ismailia Medical Complex Hospital Subjects: A convenience sampling of 60 nurses from the previous mentioned settings. Tools: Two tools were used to collect data (pre and post training) Tool (1): Structure interviewed schedule to assess nurses' knowledge related to open endotracheal suctioning, Tool (2): Observation checklist to assess nurses' practice regarding evidence based recommendations related to open endotracheal suctioning. Results: Revealed that, statistically significant improvement in the knowledge and practices of the studied nurses regarding endotracheal suction post implementation of the training than pre-implementation. Also, there was a positive correlation between total nurses' knowledge and practices post implementation of the educational training. Conclusion: Studied nurses' total knowledge and practice scores regarding endotracheal suction were improved post-implementation of the training recommendations than pre-training implementation. Recommendations: The study, emphasized on the importance of continuous training programs for pediatric nurses regarding endotracheal suction and importance of evidence based guidelines to be announced in neonatal intensive care units.