Role of lung ultrasound in predicting extubation success in mechanically ventilated neonates

Both inborn and outborn neonates fulfilling inclusion criteria will ne enrolled. Initially in pre- initiation training, a senior resident will be trained by consultant neonatologist for 1 month. To decrease inter observer variability when k > 0.8, study will be initiated. Subjects will be enrolled 2 hours before extubation. Demographics and perinatal details will be collected. Babies admitted to NICU will be followed prospectively and details of management will be recorded like whether received  surfactant or  not indication of ventilation, mode and  duration of ventilation, settings of ventilator, maximum ventilation index during ventilation,  maximum respiratory severity score (RSS) during ventilation. Lung USG score will be done within 2 hours before extubation. Baby can be extubated if FiO2 requirement < 40 %,   MAP < 8- 10cm H2O,  Respiratory rate of the ventilator < 30/min,   presence of spontaneous breathing,  haemodynamically stable without or with 1 ionotrope, last haemoglobin>10 mg/dl , no metabolic acidosis (pH>7.2)  with PaCO2- < 55mmHg, PaO2>40 mmHg  in arterial blood gas (ABG) done 2 hours before extubation or based on clinical judgement of consultant neonatologist. Post extubation neonate will be shifted to non invasive mode of ventilation (NIV). Lung ultrasound score of those who failed the first extubation attempt and those who were successful will be compared to develop final cut off score for extubation success.