Background: Several neonatal chest conditions require Invasive mechanical ventilation, which is lifesaving for the critically ill neonates. Limiting the duration of airway intubation and mechanical ventilator support is crucial. Weaning from mechanical ventilation induces significant changes in lung aeration which can be easily detected by lung sonography. Aim of the Work:Is to identify the role of pulmonary sonography in evaluation of the artificially ventilated neonates. Patients and Methods:The study included 40 neonates suffering from peripheral diseases requiring mechanical ventilation. All patients had chest ultrasound studies after clinical assessment. Chest ultrasound was performed during the different modes of mechanical ventilation including Assisted Controlled Ventilation (AC), Synchronized Intermittent Mechanical Ventilation (SIMV) and before extubation, follow-up the patients for 48 hours postextubation to assess if its failure occurred. Lung ultrasound was done using a standardized evaluation of lung aeration, i.e. Lung Ultrasound Score (LUS). Other traditional investigations including blood gases and chest X-ray were performed as well.Results: LUS was significantly higher in the 10 patients with post extubation failure. A cut off value of LUS of >13 was highly sensitive and specific for failure of switching from AC to SIMV mode and >6 prior to extubation was indicative of post extubation failure. Conclusion:Chest ultrasound provides a rapid, non invasive, objective and reliable tool for guiding the mechanical ventilation weaning process in neonates through the LUS with high confidence even when compared to other traditional indices as blood gases and respiratory mechanics. A cut off value of LUS of >13 was highly sensitive and specific for failure of switching from AC to SIMV mode and >6 prior to extubation was indicative of post extubation failure.