The aim of this study was to assess if the chest radiograph appearance at seven days of age could be used to predict chronic lung disease (oxygen dependency at 28 days of age). Sixty preterm infants (median gestational age 28 weeks), who were ventilated and/or had supplementary oxygen at seven days of age and had a chest radiograph performed at that postnatal age, were prospectively recruited. These chest radiographs were scored according to lung volume, presence of opacification, haziness, interstitial changes and cystic elements (maximum scorc 18). Twenty‐eight infants subsequently developed chronic lung disease; their median chest radiograph score was 5.5 (range 2–14) which was significantly higher than that of the non‐chronic lung disease incants (median 3; range 0–6). A chest radiograph score of 4 had a 71%, sensitivity and 88% specificity in predicting chronic lung disease. We conclude that chest radiograph appearance at seven days of age is a sensitive and specific predictor of chronic lung disease and thus could be used to indicate the need for preventive