Objective: To explore the value of cranial ultrasound in assessing cerebral hemodynamic changes in high-risk neonates and its predictive value for neurodevelopment. Methods: A total of 102 high-risk neonates admitted to the neonatal intensive care unit (NICU) of our hospital from April 1, 2022 to June 1, 2023 were retrospectively included as research subjects. General data of neonates were collected, and cranial ultrasound was used to detect changes in cerebral blood flow parameters in neonates, including peak systolic blood flow velocity (PSV), end-diastolic blood flow velocity (EDV), vascular resistance index (RI), and pulsatility index (PI). Neonatal neurodevelopment was recorded by follow-up 6 months after discharge, and the neonates were divided into an abnormal group (45 cases) and a normal group (57 cases). Logistic regression analysis was used to analyze the factors related to neonatal neurodevelopment; the receiver operating characteristic curve (ROC) was used to analyze the value of cerebral blood flow parameters in predicting neonatal neurodevelopment. Results: The 1-min Apgar score of the abnormal group was lower than that of the normal group (P<0.05); the RI and PI of the abnormal group were higher than those of the normal group, and the PSV and EDV were lower than those of the normal group (P<0.05). Multivariate logistic regression analysis showed that RI and PI were risk factors for neurodevelopmental abnormalities in high-risk neonates, and PSV and EDV were protective factors for neurodevelopmental abnormalities in high-risk neonates (P<0.05). ROC results showed that the AUCs of PSV, EDV, RI, PI and combined prediction of neurodevelopmental abnormalities in high-risk neonates were 0.861, 0.868, 0.818, 0.872 and 0.983; AUC comparison results showed that combined prediction was better than single prediction (z=3.751, 4.133, 3.052, P<0.05). Conclusion: Cranial ultrasound assessment of cerebral hemodynamic changes has a certain predictive value for brain injury in high-risk neonates.