Objective: Neonatal respiratory distress syndrome (NRDS) has become a clinically high-risk respiratory disease, with epidemiological investigations indicating an incidence of approximately 3.3%. Methods: Pulmonary ultrasonography was performed prior to treatment with Exogenous Pulmonary Surfactant (EPS) and Continuous Positive Airway Pressure (CPAP) or Conventional Mechanical Ventilation (CMV).Simultaneous blood gas analysis and chest X-ray (CXR) examination as was also performed. Three types of ultrasound diagnostic criteria were developed to diagnose preterm infants with NRDS(diagnostic criteria A, B and C). The sensitivity, specificity, Kappa value and ROC curve of different pulmonary ultrasonography diagnostic criteria were evaluated. Results: One hundred and nine preterm infants with NRDS were prospectively recruited. The sensitivity and negative predictive value of NRDS in preterm infants with A diagnostic criteria were 100%. The B diagnostic criteria sensitivity and negative predictive values were higher than the C diagnostic criteria(p<0.05), especially the sensitivity was significantly higher than the C diagnostic criteria(p<0.05). Of the 31 NRDS, 15 cases had the severe disease and other 16 had none severe NRDS. According to the C diagnostic standard, the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of sever NRDS were 73.33% (44.83%～91.09%), 93.75% (67.71%～99.67%),91.66%(59.75%～99.56%), 78.94%(53.90%～93.02%) with the Kappa value and AUC of 0.676, 0.835 respectively. Conclusion Pleural line thickening or rough with white lung sign is an important image features for diagnosis of NRDS by pulmonary ultrasonography. White lung sign combined with the lung consolidation sign had high diagnostic efficacy in detection severe NRDS from none sever NRDS.