Objective: Very low birth weight (VLBW) infants often require invasive mechanical ventilation. However, determining when infants should be extubated remains a clinical decision, and extubation trials often fail. Bedside lung ultrasound (LUS) scoring in VLBW infants allows assessment of lung aeration. Lung ultrasound scores may be helpful in determining the success of an extubation attempt. We assessed the utility of the LUS score to predict extubation readiness in VLBW infants and assessed the effect of postnatal steroids on lung ultrasound scores in babies who were ventilated for > 30 days. Study Design: Study participants were invasively mechanically ventilated VLBW infants. We measured infants’ LUS scores before planned extubations, determined the success of the extubation attempt and compared scores between successfully and unsuccessfully extubated infants. Results: VLBW infants (N=45), with gestational age 27±2 weeks and birth weight 858±289 grams, were studied. LUS scores were lower in successfully extubated infants (median 5, IQR 2-8) compared with those of unsuccessfully extubated infants (12, IQR 9.12; p=0.001). No infant with LUS <7 failed extubation. LUS scores were higher in babies ventilated >30 days (median 10, IQR 7-12) compared with babies ventilated <30 days (4; IQR 2-8, P<0.005). In infants ventilated > 30 days, LUS scores did not differ between infants treated or not with postnatal steroids. Conclusions: Lung ultrasound scores are excellent predictors of extubation readiness in VLBW infants. Lung ultrasound scores are higher in chronically ventilated infants. Use of postnatal steroids does not affect the lung ultrasound scores at the time of extubation.