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Abstract Background Lung ultrasound has been increasingly studied as an evaluation tool in RDS. Ultrasound is non-ionizing, low-cost, easy to operate, and can be performed at bedside, making this technique ideal for use in NICU.Many LUS scores are currently used to perform an assessment of lung aeration and guide respiratory care in RDS. We investigate the LUSsc as a predictive tool of readiness for extubation in ventilated preterm babies suffering from RDS. Persistent pulmonary hypertension occurs secondary to certain neonatal pulmonary diseases mainly RDS, which leads to delayed relaxation of the pulmonary vascular bed.This leads to more need to oxygen support and delayed extubation. We assess the use of left ventricular eccentricity index as a marker for high pulmonary artery pressure and oxygenation status in ventilated preterm neonates suffering from RDS Methods This was a prospective cohort study of premature neonates < 34 weeks gestation admitted to Neonatal Intensive Care Unit of Kasr El Aini Hospital, a referral tertiary University Hospital between March 2018 to March 2019. With institutional Research Ethics Board approval, infants with respiratory distress syndrome and requiring mechanical ventilation were recruited following informed parental consent. Infants with major congenital anomalies, perinatal asphyxia, or hemodynamically unstable and requiring cardiovascular support were excluded |