Background: In an intensive care unit, weaning patients off of artificial breathing remains one of the most important decisions.  
Aim of the work: to assess thoracic fluid content (TFC) as an innovative measure for prediction of successful weaning of neonates on mechanical ventilation.  
Patient and Methods: Forty neonates who met the inclusion criteria for this prospective observational study were divided into 3 groups; first group: 25 patients who were successfully extubated from the first time, second group: 15 patients who failed extubation and were re-intubated and third group:15 who were successfully extubated after initial failure. Thoracic fluid content was assessed with the use of electrical cardiometry for each participant before and after extubation from mechanical ventilation and echocardiography was also performed for each studied neonate before and after extubation.
Results: Most baseline variables were similar among the groups under study; however, compared to the successful weaning groups, the failed weaning group's TFC was significantly higher. The optimal cut off point was determined by analyzing the region beneath the ROC, or receiver operating characteristic curve. Regarding the use of TFC prior to extubation in order to identify failure cases, the AUC was 0.997 at a cut-off point of >44, with 100% sensitivity and 96.0% specificity, a PPV of 93.7, and an NPV of 100.0. AUC was 100, PPV was 100, NPV was 100.0, and it had 100% sensitivity and 100% specificity at the cut-off point of >41.
Conclusion: The thoracic fluid content (TFC) by Electric cardiometer prior to extubation is a good predictive marker of successful weaning, with high sensitivity and specificity. Patients with Thoracic fluid content >44 was expected to fail extubation and patients with TFC< 41 were expected to be extubated successfully.