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BackgroundRespiratory distress syndrome (RDS) continues to represent a crucial problem for preterm neonates despite the new advancement in its management. Currently, management of RDS is mainly through using early continuous positive airway pressure (CPAP) in the management of preterm neonates since birth together with early selective administration of surfactant. Lung ultrasound (LUS), as a simple and non-invasive diagnostic technique with no exposure to ionizing radiation, can be used as a reliable diagnostic tool for diagnosis of neonatal respiratory distress syndrome with good sensitivity and specificity. AimAssess the applicability of lung ultrasonography for early prediction of the surfactant need in preterm neonates ≤ 34 weeks treated with CPAP. Patients /MethodsWe studied 60 neonates ≤ 34 weeks treated with early CPAP; LUS was done in the first 2 hours of life. 16 neonates received surfactant therapy according to European guidelines 2019 update. We assess reliability of LUS score for prediction of surfactant treatment. ResultsThe result of our study shows that in the group received surfactant the median LUS score was 10, While in the group didn't need surfactant therapy the median LUS score was 4. About reliability of LUS score for prediction of surfactant treatment. Our results showed that LUS score at a cut off value of ≥ 6 has a sensitivity of 93.8 % and specificity of 84.1 %.while Chest X ray score at a cut off value of ≥ 5 has a sensitivity of 81.3 % and specificity of 77.3 %. ConclusionLUS score is a useful tool in early prediction of need for surfactant administration in preterm neonates on CPAP.

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