objective: To investigate the feasibility of evaluating pulmonary lesions and prognosis of neonatal respiratory distress syndrome (RDS) by pulmonary ultrasound. Methods: 120 neonates with respiratory distress syndrome who were admitted to our hospital and suspected to be respiratory distress syndrome were collected from September 2017 to October 2018. Pulmonary ultrasound and chest X-ray examination were performed in 120 newborns with dyspnea. The sensitivity, specificity and accuracy of X-ray in the diagnosis of respiratory distress syndrome were calculated and compared. The consistency of diagnosis results was analyzed. According to the criteria of transabdominal lung grade and the ultrasound image of the newborn lung, the pulmonary pathological changes of the newborns were evaluated, and the pulmonary ultrasound scores of the neonates with respiratory distress syndrome and those with the non-respiratory distress syndrome were compared. Mechanical ventilation and pulmonary surfactant therapy were applied to neonates with respiratory distress syndrome. Results: Of 120 newborns with dyspnea, 90 cases were confirmed as respiratory distress syndrome by clinical comprehensive diagnosis and 30 cases with non-respiratory distress syndrome, which were confirmed as temporary respiratory quickening syndrome. The sensitivity, specificity and accuracy of ultrasound in the diagnosis of respiratory distress syndrome were higher than that of X-ray (P < 0.05). The consistency analysis showed that the consistency between X-ray diagnosis and clinical comprehensive diagnosis was moderate (Kappa=0.607), while the consistency between ultrasound diagnosis and clinical comprehensive diagnosis was good (Kappa=0.789). The pulmonary ultrasound scores of neonates with double lung, left lung, right lung, double lung floor and respiratory distress syndrome were lower than those of non-respiratory distress syndrome newborns (P < 0.05), and after treatment, the lung ultrasound scores of neonates with respiratory distress syndrome were higher than those before treatment (P < 0.05). Conclusion: Ultrasound can be sensitive and accurate in detecting neonatal respiratory distress syndrome, and the pulmonary ultrasound score can reflect the pulmonary lesions and prognosis of the newborn. It can be used as a clinical diagnosis of neonatal respiratory distress syndrome. Methods for judging pulmonary lesions and evaluating prognosis.